Shared Decision-Making Training for Home Care Teams to Engage Frail Older Adults and Caregivers in Housing Decisions: Stepped-Wedge Cluster Randomized Trial

Évèhouénou Lionel Adisso^{1

2

3}, Monica Taljaard^{4

5}, Dawn Stacey^{4

6}, Nathalie Brière⁷, Hervé Tchala Vignon Zomahoun^{1

2

3

8

9}, Pierre Jacob Durand^{2

3

7}, Louis-Paul Rivest^{10

11}, France Légaré^{1

2

8

12}

Affiliations

¹ Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Québec, QC, Canada.
² VITAM - Centre de recherche en santé durable, Quebec, QC, Canada.
³ Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada.
⁴ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
⁵ School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
⁶ School of Nursing, University of Ottawa, Ottawa, ON, Canada.
⁷ Direction des services multidisciplinaires, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada.
⁸ Knowledge Translation and Implementation Component of the Quebec Strategy for Patient-Oriented Research - Support for People and Patient-Oriented Research and Trials Unit, Health and Social Services Systems, Quebec, QC, Canada.
⁹ School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada.
¹⁰ Department of Mathematics and Statistics, Université Laval, Quebec, QC, Canada.
¹¹ Canada Research Chair in Statistical Sampling and Data Analysis, Laval University, Quebec, QC, Canada.
¹² Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada.

PMID: 35759791
PMCID: PMC9533197
DOI: 10.2196/39386

Shared Decision-Making Training for Home Care Teams to Engage Frail Older Adults and Caregivers in Housing Decisions: Stepped-Wedge Cluster Randomized Trial

Évèhouénou Lionel Adisso et al. JMIR Aging. 2022.

. 2022 Sep 20;5(3):e39386.

doi: 10.2196/39386.

Authors

Affiliations

¹ Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Québec, QC, Canada.
² VITAM - Centre de recherche en santé durable, Quebec, QC, Canada.
³ Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada.
⁴ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
⁵ School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
⁶ School of Nursing, University of Ottawa, Ottawa, ON, Canada.
⁷ Direction des services multidisciplinaires, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada.
⁸ Knowledge Translation and Implementation Component of the Quebec Strategy for Patient-Oriented Research - Support for People and Patient-Oriented Research and Trials Unit, Health and Social Services Systems, Quebec, QC, Canada.
⁹ School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada.
¹⁰ Department of Mathematics and Statistics, Université Laval, Quebec, QC, Canada.
¹¹ Canada Research Chair in Statistical Sampling and Data Analysis, Laval University, Quebec, QC, Canada.
¹² Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada.

PMID: 35759791
PMCID: PMC9533197
DOI: 10.2196/39386

Abstract

Background: Frail older adults and caregivers need support from their home care teams in making difficult housing decisions, such as whether to remain at home, with or without assistance, or move into residential care. However, home care teams are often understaffed and busy, and shared decision-making training is costly. Nevertheless, overall awareness of shared decision-making is increasing. We hypothesized that distributing a decision aid could be sufficient for providing decision support without the addition of shared decision-making training for home care teams.

Objective: We evaluated the effectiveness of adding web-based training and workshops for care teams in interprofessional shared decision-making to passive dissemination of a decision guide on the proportion of frail older adults or caregivers of cognitively-impaired frail older adults reporting active roles in housing decision-making.

Methods: We conducted a stepped-wedge cluster randomized trial with home care teams in 9 health centers in Quebec, Canada. Participants were frail older adults or caregivers of cognitively impaired frail older adults facing housing decisions and receiving care from the home care team at one of the participating health centers. The intervention consisted of a 1.5-hour web-based tutorial for the home care teams plus a 3.5-hour interactive workshop in interprofessional shared decision-making using a decision guide that was designed to support frail older adults and caregivers in making housing decisions. The control was passive dissemination of the decision guide. The primary outcome was an active role in decision-making among frail older adults and caregivers, measured using the Control Preferences Scale. Secondary outcomes included decisional conflict and perceptions of how much care teams involved frail older adults and caregivers in decision-making. We performed an intention-to-treat analysis.

Results: A total of 311 frail older adults were included in the analysis, including 208 (66.9%) women, with a mean age of 81.2 (SD 7.5) years. Among 339 caregivers of cognitively-impaired frail older adults, 239 (70.5%) were female and their mean age was 66.4 (SD 11.7) years. The intervention increased the proportion of frail older adults reporting an active role in decision-making by 3.3% (95% CI -5.8% to 12.4%, P=.47) and the proportion of caregivers of cognitively-impaired frail older adults by 6.1% (95% CI -11.2% to 23.4%, P=.49). There was no significant impact on the secondary outcomes. However, the mean score for the frail older adults' perception of how much health professionals involved them in decision-making increased by 5.4 (95% CI -0.6 to 11.4, P=.07) and the proportion of caregivers who reported decisional conflict decreased by 7.5% (95% CI -16.5% to 1.6%, P=.10).

Conclusions: Although it slightly reduced decisional conflict for caregivers, shared decision-making training did not equip home care teams significantly better than provision of a decision aid for involving frail older adults and their caregivers in decision-making.

Trial registration: ClinicalTrials.gov NCT02592525; https://clinicaltrials.gov/show/NCT02592525.

Keywords: home care; nursing homes; patient engagement; shared decision-making.

©Évèhouénou Lionel Adisso, Monica Taljaard, Dawn Stacey, Nathalie Brière, Hervé Tchala Vignon Zomahoun, Pierre Jacob Durand, Louis-Paul Rivest, France Légaré. Originally published in JMIR Aging (https://aging.jmir.org), 20.09.2022.

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Conflict of interest statement

Conflicts of Interest: DS holds a University of Ottawa research chair in knowledge translation to patients. The authors have no further conflcits of interest to declare.

Figures

**Figure 1**
Flow chart of trial by allocated sequence and period_updated.

See this image and copyright information in PMC

References

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Shared Decision-Making Training for Home Care Teams to Engage Frail Older Adults and Caregivers in Housing Decisions: Stepped-Wedge Cluster Randomized Trial

Affiliations

Shared Decision-Making Training for Home Care Teams to Engage Frail Older Adults and Caregivers in Housing Decisions: Stepped-Wedge Cluster Randomized Trial

Authors

Affiliations

Abstract

Conflict of interest statement

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References

Associated data

LinkOut - more resources

Full Text Sources

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