Older Patients' Verbal Communication in Interactions With Primary Care Staff: A Qualitative Systematic Review and Meta-Ethnography.

backgroundCommunication between patients and staff is a crucial component of safe and effective healthcare. As people age, they have more consultations and these become more complex. As such, older people may be more likely to experience gaps and breakdowns in communication.

objectiveTo develop a better understanding of older people's communication in interactions with primary care staff and the barriers to and enablers of this. SEARCH STRATEGY: Four databases were searched. Search terms covered the sample (older people), domain (verbal communication in healthcare interactions), context (primary care) and research type (qualitative research). DATA EXTRACTION AND SYNTHESIS: A meta-ethnographic approach was followed by one researcher, with input from the wider team. Twelve studies were included. Details of the designs, participants, methods and results were extracted. Data were synthesised through reciprocal translation, and a line of argument was developed. MAIN

resultsBarriers to communication were found in relation to raising and addressing concerns. Barriers arose from patient perceptions of their role, the nature of their relationship with staff, patient and staff perceptions of responsibility and reluctance to broach a topic, individual factors such as memory, how staff respond when concerns are raised and the degree of patient involvement in consultations. Potential enablers of communication were preparation and support from family or peers.

conclusionsSynthesising the existing qualitative literature on older people's communication in healthcare interactions enabled the identification of barriers and enablers that can be used to inform the development of an intervention to improve communication with primary care staff. PATIENT OR PUBLIC CONTRIBUTION: By identifying healthcare communication as the most important topic for the patient safety of older people with multiple long-term conditions in primary care and setting the scope of the review, patients and the public were involved in the design of the study. Four public contributors (older people with multiple long-term conditions and carers of older people with multiple long-term conditions) attended regular meetings, provided their reflections on the study findings and supported the interpretation of the data.