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      Implementing shared decision-making in interprofessional home care teams (the IPSDM-SW study): protocol for a stepped wedge cluster randomised trial

      protocol

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          Abstract

          Introduction

          The frail elderly in Canada face a tough decision when they start to lose autonomy: whether to stay at home or move to another location. This study seeks to scale up and evaluate the implementation of shared decision-making (SDM) in interprofessional (IP) home care teams caring for elderly clients or their caregivers facing a decision about staying at home or moving elsewhere.

          Methods

          A stepped wedge cluster randomised trial involving 8 Health and Social Service Centers (HSSCs) will be conducted with IP home care teams. HSSCs are the unit of randomisation. A decision guide will be passively distributed to all of the participating HSSCs at the beginning of the project. The participating HSSCs will then be randomised to 1 of 4 intervention start times, separated by 7-month intervals. The primary outcome is whether or not clients and caregivers assumed an active role in decision-making, assessed with a modified version of the Control Preferences Scale. The intervention, targeted at IP home care teams, consists of a 1.5 hour online tutorial and a 3.5 hour skills building workshop in IP SDM. Clients will be eligible for outcome assessment if they (1) are aged ≥65; (2) are receiving care from the IP home care team of the enrolled HSSCs; (3) have made a decision about whether to stay at home or move to another location during the recruitment periods; (4) are able to read, understand and write French or English; (5) can give informed consent. If clients are not able to provide informed consent, their primary caregiver will become the eligible participant.

          Ethics and dissemination

          Ethics committee review approval has been obtained from the Multicenter Ethics Committee of CISSS-Laval. Results will be disseminated at conferences, on websites of team members and in peer-reviewed and professional journals intended for policymakers and managers.

          Trial registration number

          NCT02592525, Pre-results.

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          Most cited references28

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          Self-rated health and mortality: a review of twenty-seven community studies.

          We examine the growing number of studies of survey respondents' global self-ratings of health as predictors of mortality in longitudinal studies of representative community samples. Twenty-seven studies in U.S. and international journals show impressively consistent findings. Global self-rated health is an independent predictor of mortality in nearly all of the studies, despite the inclusion of numerous specific health status indicators and other relevant covariates known to predict mortality. We summarize and review these studies, consider various interpretations which could account for the association, and suggest several approaches to the next stage of research in this field.
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            Validation of a decisional conflict scale.

            The study objective was to evaluate the psychometric properties of a decisional conflict scale (DCS) that elicits: 1) health-care consumers' uncertainty in making a health-related decision; 2) the factors contributing to the uncertainty; and 3) health-care consumers' perceived effective decision making. The DCS was developed in response to the lack of instruments available to evaluate health-care-consumer decision aids and to tailor decision-supporting interventions to particular consumer needs. The scale was evaluated with 909 individuals deciding about influenza immunization or breast cancer screening. A subsample of respondents was retested two weeks later. The test-retest reliability coefficient was 0.81. Internal consistency coefficients ranged from 0.78 to 0.92. The DCS discriminated significantly (p < 0.0002) between those who had strong intentions either to accept or to decline invitations to receive influenza vaccine or breast cancer screening and those whose intentions were uncertain. The scale also discriminated significantly (p < 0.0002) between those who accepted or rejected immunization and those who delayed their decisions to be immunized. There was a weak inverse correlation (r = -0.16, p < 0.05) between the DCS and knowledge test scores. The psychometric properties of the scale are acceptable. It is feasible and easy to administer. Evaluations of responsiveness to change and validation with more difficult decisions are warranted.
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              Validation of a decision regret scale.

              As patients become more involved in health care decisions, there may be greater opportunity for decision regret. The authors could not find a validated, reliable tool for measuring regret after health care decisions. A 5-item scale was administered to 4 patient groups making different health care decisions. Convergent validity was determined by examining the scale's correlation with satisfaction measures, decisional conflict, and health outcome measures. The scale showed good internal consistency (Cronbach's alpha = 0.81 to 0.92). It correlated strongly with decision satisfaction (r = -0.40 to -0.60), decisional conflict (r = 0.31 to 0.52), and overall rated quality of life (r = -0.25 to -0.27). Groups differing on feelings about a decision also differed on rated regret: F(2, 190) = 31.1, P < 0.001. Regret was greater among those who changed their decisions than those who did not, t(175) = 16.11, P < 0.001. The scale is a useful indicator of health care decision regret at a given point in time.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2016
                24 November 2016
                : 6
                : 11
                : e014023
                Affiliations
                [1 ]CHU de Québec Research Centre, Saint-François d'Assise Hospital , Quebec City, Quebec, Canada
                [2 ]Faculty of Medicine, Université Laval , Quebec City, Quebec, Canada
                [3 ]Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Direction des services multidisciplinaires , Quebec City, Quebec, Canada
                [4 ]Clinical Epidemiology Program, Ottawa Hospital Research Institute , Ottawa, Ontario, Canada
                [5 ]School of Nursing, University of Ottawa , Ottawa, Ontario, Canada
                [6 ]Faculty of Social Sciences, Université Laval , Quebec City, Quebec, Canada
                [7 ]School of Nutrition, Université Laval , Quebec City, Quebec, Canada
                [8 ]Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, CERSSPL-UL , Quebec City, Quebec, Canada
                [9 ]Faculty of Nursing, University of Alberta , Edmonton, Alberta, Canada
                [10 ]Faculty of Sciences and Engineering, Université Laval , Quebec City, Quebec, Canada
                [11 ]School of Epidemiology, University of Ottawa , Ottawa, Ontario, Canada
                [12 ]Caregivers’ representative, CHU de Québec Research Centre, Saint-François d'Assise Hospital , Quebec City, Quebec, Canada
                Author notes
                [Correspondence to ] Dr France Légaré; france.legare@ 123456mfa.ulaval.ca
                Article
                bmjopen-2016-014023
                10.1136/bmjopen-2016-014023
                5168494
                27884857
                d9388d1f-1746-43ba-9d95-5de607bf2937
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                : 25 August 2016
                : 21 October 2016
                : 27 October 2016
                Funding
                Funded by: Canadian Institutes of Health Research, http://dx.doi.org/10.13039/501100000024;
                Award ID: 201403MOP-325236-KTR-CFBA-19158
                Categories
                Patient-Centred Medicine
                Protocol
                1506
                1722
                1694
                1698
                1704
                1709
                1720

                Medicine
                frail elderly,home care services,shared decision making,interprofessional collaboration,knowledge translation

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