Implementing Shared Decision Making in Interprofessional Home Care Teams

Study Overview
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Brief Summary
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This study will train health providers in home care teams across Quebec in shared decision making about the decision to stay at home or move to another location. This decision is one of the toughest for older Canadians. Decisions that are informed, shared and supported produce better results. An interprofessional approach to shared decision making is when older persons and their caregivers are supported by not just one but by all the professionals involved in their care.The impact of the training program in interprofessional shared decision making (IPSDM) above that of the passive dissemination of a decision guide will be assessed by measuring to what extent older persons caregivers say they took active part in the decision-making process. Other outcome measures will be: i) what option they chose, whether they feel conflict or regret about their decision, and the burden of care they feel; ii) the quality of life of clients;

Official Title
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Implementing Shared Decision Making in Interprofessional Home Care Teams : a Stepped Wedge Cluster Randomized Trial

Conditions
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Aging

Intervention / Treatment
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* Behavioral: IP-SDM training for health professionals


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Clients or caregivers of clients : Aged ≥65 years; Receiving care from the IP home care team of the enrolled CISSS/CIUSSS Have made a decision about whether to stay at home or move to another location during the recruitment periods Are able to read, understand and write French or English Can give informed consent In the case clients are not able to provide informed consent, their caregiver will be eligible. Exclusion Criteria: Clients who are not able to provide informed consent and who don't have a caregiver
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Cluster A<br>IP-SDM training for health professionals (intervention at 4 months) | Behavioral: IP-SDM training for health professionals<br>* Multifaceted SDM training program for providers: i) 1.5-hour online tutorial, ii) 3.5-hour skills building workshop; iii) video-clip demonstrating SDM in the context of an IP home care team with an aging adult making a decision about location of care (to be used with clients and providers as well); and iv) performance feedback to providers (role play during the workshop).<br>|
| Experimental: Cluster B<br>IP-SDM training for health professionals (intervention at 11 months) | Behavioral: IP-SDM training for health professionals<br>* Multifaceted SDM training program for providers: i) 1.5-hour online tutorial, ii) 3.5-hour skills building workshop; iii) video-clip demonstrating SDM in the context of an IP home care team with an aging adult making a decision about location of care (to be used with clients and providers as well); and iv) performance feedback to providers (role play during the workshop).<br>|
| Experimental: Cluster C<br>IP-SDM training for health professionals (intervention at 18 months) | Behavioral: IP-SDM training for health professionals<br>* Multifaceted SDM training program for providers: i) 1.5-hour online tutorial, ii) 3.5-hour skills building workshop; iii) video-clip demonstrating SDM in the context of an IP home care team with an aging adult making a decision about location of care (to be used with clients and providers as well); and iv) performance feedback to providers (role play during the workshop).<br>|
| Experimental: Cluster D<br>IP-SDM training for health professionals (intervention at 25 months) | Behavioral: IP-SDM training for health professionals<br>* Multifaceted SDM training program for providers: i) 1.5-hour online tutorial, ii) 3.5-hour skills building workshop; iii) video-clip demonstrating SDM in the context of an IP home care team with an aging adult making a decision about location of care (to be used with clients and providers as well); and iv) performance feedback to providers (role play during the workshop).<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Assumed Role in decision making | To assess the proportion of caregivers reporting an active role, a modified version of the Control Preferences Scale designed to assess the role assumed in the decision making process will be used. The scale consists of a single question and is the one most frequently used in studies assessing the implementation of SDM in clinical practice. | 7 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patient involvement in decision making | Assessed with the Dyadic-OPTION scale, a 12-item self-administered instrument that assesses 12 specific SDM behaviours during the decision-making process | 7 months | 
| Decisional Regret | Assessed with the Decisional Regret Scale | 7 months | 
| Decisional Conflict | Assessed with the Decisional Conflict Scale | 7 months | 
| Health-related quality of life | Assessed with two subscales (Social isolation and Emotional reactions) of the HR-QoL questionnaire from the Nottingham Health Profile, clients only | 7 months | 
| Burden of care | Assessed with the Zarit Burden Inventory Scale (ZBI), caregivers only | 7 months | 
| Preferred and chosen option (remain at home or move to another location) | Questionnaire assessing the prefered and chosen option | 7 months |