Most shared decision-making (SDM) models within healthcare have been limited to the patient-physician dyad. As a first step towards promoting an interprofessional approach to SDM in primary care, ...this article reports how an interprofessional and interdisciplinary group developed and achieved consensus on a new interprofessional SDM model. The key concepts within published reviews of SDM models and interprofessionalism were identified, analysed, and discussed by the group in order to reach consensus on the new interprofessional SDM (IP-SDM) model. The IP-SDM model comprises three levels: the individual (micro) level and two healthcare system (meso and macro) levels. At the individual level, the patient presents with a health condition that requires decision-making and follows a structured process to make an informed, value-based decision in concert with a team of healthcare professionals. The model acknowledges (at the meso level) the influence of individual team members' professional roles including the decision coach and organizational routines. At the macro level it acknowledges the influence of system level factors (i.e. health policies, professional organisations, and social context) on the meso and individual levels. Subsequently, the IP-SDM model will be validated with other stakeholders.
DOLCE (Improving Decision making On Location of Care with the frail Elderly and their caregivers) was a post-intervention clustered randomised trial (cRT) to assess the effect of training home care ...teams on interprofessional shared decision-making (IP-SDM). Alongside the cRT, we sought to monitor healthcare providers' level of behavioural intention to engage in an IP-SDM approach and to identify factors associated with this intention.
We conducted two cross-sectional surveys in the province of Quebec, Canada, one each at cRT entry and exit. Healthcare providers (e.g. nurses, occupational therapists and social workers) in the 16 participating intervention and control sites self-completed an identical paper-based questionnaire at entry and exit. Informed by the Integrated model for explaining healthcare professionals' clinical behaviour by Godin et al. (2008), we assessed their behavioural intention to engage in IP-SDM to support older adults and caregivers of older adults with cognitive impairment to make health-related housing decisions. We also assessed psychosocial variables underlying their behavioural intention and collected sociodemographic data. We used descriptive statistics and linear mixed models to account for clustering.
Between 2014 and 2016, 271 healthcare providers participated at study entry and 171 at exit. At entry, median intention level was 6 in a range of 1 (low) to 7 (high) (Interquartile range (IQR): 5-6.5) and factors associated with intention were social influence (β = 0.27, P < 0.0001), beliefs about one's capabilities (β = 0.43, P < 0.0001), moral norm (β = 0.31, P < 0.0001) and beliefs about consequences (β = 0.21, P < 0.0001). At exit, median intention level was 5.5 (IQR: 4.5-6.5). Factors associated with intention were the same but did not include moral norm. However, at exit new factors were kept in the model: working in rehabilitation (β = - 0.39, P = 0.018) and working as a technician (β = - 0.41, P = 0.069) (compared to as a social worker).
Intention levels were high but decreased from entry to exit. Factors associated with intention also changed from study entry to study exit. These findings may be explained by the major restructuring of the health and social care system that took place during the 2 years of the study, leading to rapid staff turnover and organisational disturbance in home care teams. Future research should give more attention to contextual factors and design implementation interventions to withstand the disruption of system- and organisational-level disturbances.
Clinicaltrials.gov (NCT02244359). Registered on September 19th, 2014.
A descriptive, cross-sectional study was conducted to determine factors influencing Canadian oncology nurses discussing cannabis use with patients experiencing chemotherapy-induced nausea (CIN). A ...survey invitation and three reminders were sent to 678 members of the Canadian Association of Nurses in Oncology (CANO) between February 8 and April 10, 2022. An educator sent an extra invitation to 131 oncology nurses in Eastern Ontario. The survey was based on the Ottawa Model of Research Use. Twenty-seven opened the link to the survey and 25 responded. Of 25 nurses, 11 (47.8%) correctly answered the knowledge question about the effectiveness of cannabis for CIN. The top three barriers to discussing cannabis use were social stigma, nurses' lack of knowledge, and lack of guidance within the workplace. All participants identified needing continuing education and written guidance about use of cannabis for CIN. Although few oncology nurses responded to the survey, most indicated feeling inadequately prepared to discuss cannabis use with patients experiencing CIN.A descriptive, cross-sectional study was conducted to determine factors influencing Canadian oncology nurses discussing cannabis use with patients experiencing chemotherapy-induced nausea (CIN). A survey invitation and three reminders were sent to 678 members of the Canadian Association of Nurses in Oncology (CANO) between February 8 and April 10, 2022. An educator sent an extra invitation to 131 oncology nurses in Eastern Ontario. The survey was based on the Ottawa Model of Research Use. Twenty-seven opened the link to the survey and 25 responded. Of 25 nurses, 11 (47.8%) correctly answered the knowledge question about the effectiveness of cannabis for CIN. The top three barriers to discussing cannabis use were social stigma, nurses' lack of knowledge, and lack of guidance within the workplace. All participants identified needing continuing education and written guidance about use of cannabis for CIN. Although few oncology nurses responded to the survey, most indicated feeling inadequately prepared to discuss cannabis use with patients experiencing CIN.
Une étude transversale descriptive a été réalisée pour déterminer les facteurs qui incitent les infirmières canadiennes en oncologie à suggérer la prise de cannabis à leurs patients pour soulager les ...nausées et vomissements induits par chimiothérapie (NVIC). Au total, 678 membres de l’Association canadienne des infirmières en oncologie (ACIO/CANO) ont reçu, entre le 8 février et le 10 avril 2022, une invitation à répondre au sondage, suivie de trois rappels. Une infirmière enseignante a aussi envoyé l’invitation à 131 autres infirmières en oncologie de l’est de l’Ontario. Le sondage s’appuyait sur le modèle d’utilisation de la recherche d’Ottawa. En tout, 27 personnes ont ouvert le lien du sondage et 25 l’ont rempli. Onze (47,8 %) d’entre elles ont répondu à la question sur l’efficacité du cannabis pour soulager les NVIC. Les trois principaux obstacles à recommander la prise de cannabis étaient la stigmatisation sociale, le manque de connaissances des infirmières et le manque de directives au sein du milieu de travail. Tous les participants ont relevé l’importance de la formation continue et de directives écrites sur le recours au cannabis pour soulager les NVIC. Le sondage a reçu peu de réponses, mais dans l’ensemble, les répondants se disaient mal préparés pour proposer la prise de cannabis en traitement des NVIC.
Little is known about the decision-making experiences of seniors and informal caregivers facing decisions about seniors' housing decisions when objective decision making measures are used.
To report ...on seniors' and caregivers' experiences of housing decisions.
A cross-sectional study with a quantitative approach supplemented by qualitative data.
Sixteen health jurisdictions providing home care services, Quebec province, Canada.
Two separate samples of seniors aged ≥ 65 years and informal caregivers of cognitively impaired seniors who had made a decision about housing.
Information on preferred choice and actual choice about housing, role assumed in the decision, decisional conflict and decision regret was obtained through closed-ended questionnaires. Research assistants paraphrased participants' narratives about their decision-making experiences and made other observations in standardized logbooks.
Thirty-one seniors (median age: 85.5 years) and 48 caregivers (median age: 65.1 years) were recruited. Both seniors and caregivers preferred that the senior stay at home (64.5% and 71.7% respectively). Staying home was the actual choice for only 32.2% of participating seniors and 36.2% of the seniors cared for by the participating caregivers. Overall, 93% seniors and 71% caregivers reported taking an active or collaborative role in the decision-making process. The median decisional conflict score was 23/100 for seniors and 30/100 for caregivers. The median decision regret score was the same for both (10/100). Qualitative analysis revealed that the housing decision was influenced by factors such as seniors' health and safety concerns and caregivers' burden of care. Some caregivers felt sad and guilty when the decision did not match the senior's preference.
The actual housing decision made for seniors frequently did not match their preferred housing option. Advanced care planning regarding housing and better decision support are needed for these difficult decisions.
Choice of insulin delivery for type 1 diabetes can be difficult for many parents and children. We evaluated decision coaching using a patient decision aid for helping youth with type 1 diabetes and ...parents decide about insulin delivery method.
A pre/post design. Youth and parent(s) attending a pediatric diabetes clinic in a tertiary care centre were referred to the intervention by their pediatric endocrinologist or diabetes physician between September 2013 and May 2015. A decision coach guided youth and their parents in completing a patient decision aid that was pre-populated with evidence on insulin delivery options. Primary outcomes were youth and parent scores on the low literary version of the validated Decisional Conflict Scale (DCS).
Forty-five youth (mean age = 12.5 ± 2.9 years) and 66 parents (45.8 ± 5.6 years) participated. From pre- to post-intervention, youth and parent decisional conflict decreased significantly (youth mean DCS score was 32.0 vs 6.6, p < 0.0001; parent 37.6 vs 3.5, p < 0.0001). Youth's and parents' mean decisional conflict scores were also significantly improved for DCS subscales (informed, values clarity, support, and certainty). 92% of youth and 94% of parents were satisfied with the decision coaching and patient decision aid. Coaching sessions averaged 55 min. Parents (90%) reported that the session was the right length of time; some youth (16%) reported that it was too long.
Decision coaching with a patient decision aid reduced decisional conflict for youth and parents facing a decision about insulin delivery method.
IntroductionDecision coaching is a non-directive approach to support patients to prepare for making health decisions. It is used to facilitate patients’ involvement in informed values-based ...decision-making and use of evidence-based health information. A recent systematic review revealed low certainty evidence for its effectiveness with and without evidence-based information. However, there may be opportunities to improve the study and use of decision coaching in clinical practice by systematically investigating its determinants of practice. We aim to conduct a systematic review to identify and synthesise the determinants of practice for providing decision coaching to facilitate patient involvement in decision-making from multiple perspectives that influence its use.Methods and analysisWe will conduct a mixed-methods systematic review guided by the Cochrane’ Handbook of Systematic Reviews. We will include studies reporting determinants of practice influencing decision coaching with or without evidence-based patient information with adults making a health decision for themselves or a family member. Systematic literature searches will be conducted in Medline, EMBASE, Cochrane CENTRAL and PsycINFO via Ovid and CINAHL via EBSCO including quantitative, qualitative and mixed-methods study designs. Additionally, experts in the field will be contacted.Two reviewers will independently screen and extract data. We will synthesise determinants using deductive and inductive qualitative content analysis and a coding frame developed specifically for this review based on a taxonomy of barriers and enablers of shared decision-making mapped onto the major domains of the Consolidated Framework for Implementation Research. We will assess the quality of included studies using the Mixed Methods Appraisal Tool.Ethics and disseminationEthical approval is not required as this systematic review involves only previously published literature. The results will be published in a peer-reviewed journal, presented at scientific conferences and disseminated to relevant consumer groups.PROSPERO registration numberCRD42022338299.
The pan-Canadian Oncology Symptom Triage and Remote Support (COSTaRS) practice guides present evidence on symptom management in user-friendly formats and using plain language. The aim of this work is ...to summarize changes to the practice guides based on new evidence including management specific to immune checkpoint inhibitors (ICIs). A systematic review of literature was conducted to identify clinical practice guidelines and systematic reviews. For version 2020, there is new evidence from 86 sources (range 2–16; mean 9 per guide), including 14 specific to ICIs, and we removed 21 outdated sources. The 15 COSTaRS practice guides were updated and 2 new guides created for mouth dryness and skin rash. The National Cancer Institute’s common terminology criteria for adverse events (NCI-CTCAE) grading was added to the assessment results. “Review self-care strategies” was changed to “Review 3 or more self-care strategies”. There were changes based on new evidence and ensuring consistency across practice guides. The 2020 update was validated by oncology nurses from across Canada.
Les guides de pratique de l’équipe pancanadienne de triage des symptômes et aide à distance en oncologie (COSTaRS) présentent les données probantes sur la gestion des symptômes dans des formats ...conviviaux et un langage clair. L’objectif de ce travail est de résumer les changements apportés aux guides de pratique en fonction des nouvelles données concernant notamment la gestion spécifique des inhibiteurs de points de contrôle immunitaire (IPCI). Une revue systématique de la littérature a été réalisée afin de faire ressortir les lignes directrices de pratique clinique et les revues systématiques concernant les IPCI. La version de 2020 présente de nouvelles données provenant de 86 sources (étendue : 2–16; moyenne : 9 par guide). Parmi ces sources, 14 se rapportent spécifiquement aux IPCI, tandis que 21 sources obsolètes ont été écartées. Les 15 guides de pratiques COSTaRS ont été mis à jour et 2 nouveaux guides sur la sécheresse buccale et les éruptions cutanées ont été créés. L’échelle « Common Terminology Criteria for Adverse Events » du National Cancer Institute (NCI-CTCAE) a été ajoutée aux résultats de l’évaluation. Le critère « Vérification des stratégies d’autosoins » a été changé pour « Examen d’au moins trois stratégies de soins autoadministrés ». Des changements ont été apportés sur la base de nouvelles données, tout en veillant à la cohérence des guides de pratiques. La mise à jour de 2020 a été validée par des infirmières canadiennes en oncologie.
Abstract Background Although women face a wide range of contraceptive options, globally, young women are at risk of unintended pregnancies. Our umbrella review aimed to determine the decisional needs ...of nulligravida women aged 11 to 30 considering contraceptive options and identify effective interventions to support their involvement in making decisions about contraceptive use. Methods We followed Joanna Briggs Institute methods for umbrella reviews, theoretically guided by the Ottawa Decision Support Framework. We searched six electronic databases. Two reviewers independently screened citations, extracted data, and appraised quality using AMSTAR2. We analysed findings descriptively. Results Of 124 citations, we identified 11 reviews of variable quality (critically low to moderate quality): Six reported decisional needs and 5 reported on interventions. Decisional needs of young women were: (a) information needs about contraceptive options (e.g., mechanism of actions, eligibility, administration, side effects); (b) unclear values (concerns about hormone use) and features of different options (based on their religious values); and (c) need for support and resources (support from society and need for privacy). Compared to controls, decision support interventions including patient decision aids and patient education material increased knowledge and improved discussion of options with their clinicians. Conclusion Young women making contraceptive decisions experience unmet decisional needs. Effective interventions such as patient decision aids and general patient education materials may address their decisional needs and enhance their level of participation in making contraception decisions. Implications and contribution to the field: Young women’s decisional needs when considering contraceptive use are informational needs, unclear values (including religious influences), need for support and resources when facing this decision. Interventions, such as patient decision aid and patient education material can, address decisional needs by improving young women’s knowledge about contraceptive options.
PDF
