Improving Decision Making On Location of Care With the Frail Elderly and Their Caregivers

Study Overview
=================
Brief Summary
-----------------
One of the toughest decisions faced by the frail elderly in Canada is whether to stay at home or move to a care facility. It is certainly difficult to make this decision alone, but can be even harder if someone else makes it for you. Shared decision making is when, instead of making decisions for the patient, healthcare professionals share information about what the evidence says, and they talk about what's important with the patient, and then make the decision together. In the case of the frail elderly in home care services, there are many health care professionals involved, e.g. the doctor, nurse and social worker. In this case decisions should be shared by all the professionals involved with the elderly person along with his or her caregivers. Unfortunately, in this context, shared decision making rarely occurs. We have designed a training program that teaches interprofessional teams how to share decisions with their frail elderly patients, and tested it in one Quebec City and one Edmonton home care team. This project tests the training program on a broader scale with 16 home care teams attached to community health centres across the province of Quebec, and will compare the results with what happens when no one has completed the training (usual care). Home care is a rapidly growing sector and this study will lay the foundations for a national strategy to ensure that no one has to make this difficult decision alone.

Official Title
-----------------
Improving the Decision Making Process About Location of Care With the Frail Elderly and Their Caregivers

Conditions
-----------------
Decision Process About the Location of Care Among Frail Elderly

Intervention / Treatment
-----------------
* Behavioral: Training
* Behavioral: Usual care


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Receiving care from the home care team Faced the decision about whether to stay at home or move to a care facility in the previous 3 to 6 months Able to read, understand and write french or english Able to give informed consent For the case of clients unable to provide informed consent, their caregivers who was involved into decision making process will be eligible Exclusion Criteria: Clients who cannot provide informed consent (e. g. clients with cognitive impairment) without a caregiver Clients who require acute care hospitalization and whom the location of care decision is transferred to hospital-based social services

Ages Eligible for Study
-----------------
Minimum Age: 65 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Training<br>Online tutorial, decision aid and interactive workshop | Behavioral: Training<br> <br> |
| Other: Usual care<br>Usual care | Behavioral: Usual care<br> <br> |

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The assumed role in the decision making process, and the preferred and chosen options. | We will use the modified version of the Control Preferences Scale designed to assess the assumed role in the decision making process reported by the client. | 3 to 6 months | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Shared Decision making, Patient Centred care, Interprofessionalism, Home care, Frail elderly