Please select the eligibility criteria that correspond to the clinical trial below.
Title: SHARED DECISION MAKING ON A 'LIFE-AND-CARE PLAN' IN LONG-TERM CARE FACILITIES
Brief Summary: Shared Decision Making (SDM) is defined as a process where healthcare professionals and patients make decisions together, using the best available evidence. SDM, as a communication and decision method, can be used also with persons suffering from dementia. Yet, SDM with persons with dementia or even with their family caregivers is not widespread.

The present research project aims to develop and evaluate an SDM framework in care planning to be implemented in long-term care facilities, in order to obtain a constantly developing care plan that focuses not only on the medical, physical, psychosocial and spiritual needs of the resident, but that considers and documents his preferences and the actions taken by caregivers to meet them.

The current project is a controlled exploratory study. Case studies that involve a triad in each case, composed by the resident with moderate or severe dementia, his family caregiver and the professional usually taking care for the resident, will be used (n=16 professionals; n=40 residents; n=40 family caregivers). Professional caregivers of two nursing homes, one located in Italy and one in the Netherlands, will receive a specific training in SDM principles and will guide the SDM interview within the triad. Primary outcome will be the proportion of residents whose preferences and needs, together with the related actions to meet them, are known, documented and satisfied in their 'life-and-care plans'. Secondary outcomes are the residents' and family caregivers' quality of life; the family caregivers' sense of competence and the healthcare professionals' job satisfaction. Semi-structured interviews and focus group interviews will be performed to assess satisfaction with the intervention and barriers and facilitators to its implementation. Assessments are performed at baseline and six months after the intervention.

We hypothesize that the use of the SDM process in care planning will increase the number of met needs and will improve the residents' and family caregivers quality of life, the family caregivers' sense of competence and the healthcare professionals' job satisfaction.

The key element of this study is that it will contribute to our knowledge about the efficacy and feasibility of an SDM framework in care planning in long-term care facilities with persons with moderate to severe dementia.


Options:
A: Inclusion Criteria:

* Age 60 years and older
* Moderate to severe levels of worry

Exclusion Criteria:

* Currently receiving psychotherapy
* Currently practicing yoga
* Active alcohol/substance abuse
* Dementia
* Current psychotic symptoms
* Active suicidal ideation with plan and intent
* Hearing loss that would prevent a person from participating in telephone/class sessions
B: Inclusion Criteria:

* Patients aged 18-65 years
* PHQ-9 score of \>or=14 at baseline
* IDS-SR score of \>or=26 at baseline
* No filling of antidepressant medication prescription for 270 prior days
* Illiteracy or the lack of working telephone to receive reminders.

Exclusion Criteria:

* Current diagnosis of alcohol or substance dependence
* History of Bipolar Disorder determined by a baseline Composite International Diagnostic Interview (CIDI) screening scale of lifetime mania/hypomania
* Any current prescription for mood stabilizer or antipsychotic medication
* Female with positive pregnancy test
* General medical conditions which contraindicate antidepressant medications
* Clinical status requiring inpatient or day hospital treatment.
C: Inclusion Criteria:

* diagnosis of dementia based on the Diagnostic and Statistical Manual of Mental Disorders (DSM) IV
* from moderate to severe cognitive decline (Global Deterioration Scale from 4 to 6)
* supported by a family caregiver who can be involved

Exclusion Criteria:

* unable to pronounce simple sentences
D: Inclusion Criteria:

* currently receive services in the VASDHS PRRC

  * i.e., seen in the clinic in the past month and/or completed a PRRC group during the past trimester
* have an SMI diagnosis per the electronic medical record

  * e.g., schizophrenia, schizoaffective disorder, delusional disorder, and major depressive disorder with psychotic features
* agree to have a subset of treatment appointments audiotaped

Exclusion Criteria:

* having primary substance use or organic neurological disorder diagnosis
* are determined by PRRC and/or study staff to be at significant risk of exacerbation of symptoms, suicidal ideation, or other risk due to study participation
* have a history and/or current risk of violence that PRRC and/or study staff determine to be too high risk to manage effectively at the PRRC's outpatient clinic location (which has less police presence than the primary VASDHS hospital location)

Answer: C