Skip to main content

Table 1 The prioritised themes expressed by frail older patients and relatives going through a care transition from the hospital to their own home or rehabilitation centre

From: Involving frail older patients in identifying outcome measures for transitional care—a feasibility study

Headlines (prioritised by importance)

Themes discussed by the expert panel

Not actively prioritised by the expert panel

Care contents: overview and responsibility

Health care personnel competency, options and drive: Granted services vs. the ability to deal with current individual needs

Identify and solve practical challenges

Number of carers/ health care professionals: too many/few/late/early/often or wrong profession

   

Relatives: involvement in care decisions

Involvement of the relatives during admission: consulting the relatives’ views

Involvement in care planning: participating relatives, assigning tasks to the relatives

Relatives taking an active part in the transition: being present at discharge

Relieve burdens off relatives and avoidance of overloading

Practically possible to be involved (time, place etc.)

 

Care transition: overview, responsibility

Manager/coordinator: to clarify and define responsibilities

Knowledge about options, e.g., whom to contact in case of unforeseen events

   

Match care and treatment plan expectations to reach common agreement

Existential issues

Existential and emotional considerations and reflections during admission, transition and after discharge

     

Functional capacity, illness and disease

Physical functional capacity and social capacity: regaining loss of function

To return home

   

Diagnostic conclusion: to understand what happened

Culture

     

Cultural understanding Language barrier