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van Muijden T, Gräler L, van Exel J, van de Bovenkamp H, Petit‐Steeghs V. Different views on collaboration between older persons, informal caregivers and care professionals. Health Expect 2024; 27:e14091. [PMID: 38924218 PMCID: PMC11196834 DOI: 10.1111/hex.14091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/12/2024] [Accepted: 05/11/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Informal care features high on the policy agenda of many countries to deal with workforce shortages. As a consequence, care provision increasingly takes place in the care triad of care recipients, informal caregivers and care professionals. How collaboration between care partners takes shape depends on how the different partners perceive this collaboration. This paper aims to investigate the relative importance of the different aspects of collaboration from the perspectives of care recipients, informal caregivers and care professionals in the context of the care for older persons in The Netherlands. METHODS Using Q-methodology, 32 participants ranked 28 statements that reflect different aspects of collaboration in the care triad and explained their ranking during a follow-up interview. Participants comprised 9 older persons, 10 informal caregivers and 13 care professionals. Data were analysed using by-person factor analysis to identify common patterns in the rankings of the statements. Emerging patterns were interpreted and described as views on collaboration using aggregated rankings and qualitative data from the interviews. RESULTS Five distinct views on collaboration were found: (1) Emphasizing warm collaboration, (2) trusting care professional's expertise, (3) open and compassionate care professionals, (4) responsive decision-making by autonomous care professionals and (5) prioritizing care recipient's and informal caregiver's interests. Care recipients and/or informal caregivers were associated with views 1, 3 and, 5, whereas care professionals were associated with all five views. CONCLUSIONS Our study highlights the importance of recognizing the potential diversity of views between and within different partner groups in care triads. Governmental and organizational policy makers, as well as healthcare professionals who aim to increase or support the involvement of informal caregivers, should take this heterogeneity into consideration. PATIENT OR PUBLIC CONTRIBUTION An advisory board of older persons (care recipients and informal caregivers) was involved in the recruitment of the participants, the formulation of the statements and the reflection on the findings of the study and potential implications.
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Affiliation(s)
- Teyler van Muijden
- Healthcare GovernanceErasmus School of Health Policy & ManagementRotterdamNetherlands
| | - Leonoor Gräler
- Healthcare GovernanceErasmus School of Health Policy & ManagementRotterdamNetherlands
| | - Job van Exel
- Department of Health EconomicsErasmus School of Health Policy & ManagementRotterdamNetherlands
| | | | - Violet Petit‐Steeghs
- Healthcare GovernanceErasmus School of Health Policy & ManagementRotterdamNetherlands
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Geddis-Regan A, Wassall RR, Abley C, Exley C. Exploring dental treatment decision-making experiences of people living with dementia and family carers. Gerodontology 2024; 41:83-93. [PMID: 37036039 DOI: 10.1111/ger.12687] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2023] [Indexed: 04/11/2023]
Abstract
INTRODUCTION People living with dementia can have complex dental care needs. Dentists and patients should make treatment decisions together, yet some people living with dementia may be unable to make their own decisions about their dental care. Dental treatment decision-making and patients' experiences of this process have not been comprehensively researched. OBJECTIVE This study aimed to explore the dental treatment decision-making perspectives and experiences of people living with dementia and their family members. METHODS Semi-structured interviews were undertaken with 8 people living with dementia and 17 family caregivers. A constructivist grounded theory approach was adopted, using a maximum variation sample. Qualitative data collection and analysis occurred concurrently. Data underwent initial open coding followed by more focused coding, supported by reflexive memo writing, which supported data categorisation. RESULTS People living with dementia reported wanting to be understood as unique individuals with specific needs. All participants described wanting to be actively involved in dental treatment decisions. However, many felt that they were insufficiently involved in treatment decision-making. This perceived underinvolvement meant that some people living with dementia and family members felt the treatment outcomes they sought were neither discussed nor considered. CONCLUSION People living with dementia and carers had specific expectations of dental care yet felt passive in decision-making despite their desire to be involved in this process. Dentists should seek to actively establish patients' preferences, regardless of mental capacity and consider these in discussions and decisions about dental treatment.
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Affiliation(s)
- Andrew Geddis-Regan
- School of Dental Sciences, Newcastle University, Newcastle Upon Tyne, UK
- North Cumbria Integrated Care NHS Foundation Trust, Carlisle Dental Centre, Carlisle, UK
| | - Rebecca R Wassall
- School of Dental Sciences, Newcastle University, Newcastle Upon Tyne, UK
- Newcastle Dental Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Clare Abley
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Catherine Exley
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
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Mattos MK, Gibson JS, Wilson D, Jepson L, Ahn S, Williams IC. Shared decision-making in persons living with dementia: A scoping review. DEMENTIA 2023; 22:875-909. [PMID: 36802973 PMCID: PMC10866150 DOI: 10.1177/14713012231156976] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Evidence supports that older adults with cognitive impairment can reliably communicate their values and choices, even as cognition may decline. Shared decision-making, including the patient, family members, and healthcare providers, is critical to patient-centered care. The aim of this scoping review was to synthesize what is known about shared decision-making in persons living with dementia. A scoping review was completed in PubMed, CINAHL, and Web of Science. Keywords included content areas of dementia and shared decision-making. Inclusion criteria were as follows: description of shared or cooperative decision making, cognitively impaired patient population, adult patient, and original research. Review articles were excluded, as well as those for which the formal healthcare provider was the only team member involved in the decision-making (e.g., physician), and/or the patient sample was not cognitively impaired. Systematically extracted data were organized in a table, compared, and synthesized. The search yielded 263 non-duplicate articles that were screened by title and abstract. Ninety-three articles remained, and the full text was reviewed; 32 articles were eligible for this review. Studies were from across Europe (n = 23), North America (n = 7), and Australia (n = 2). The majority of the articles used a qualitative study design, and 10 used a quantitative study design. Categories of similar shared decision-making topics emerged, including health promotion, end-of-life, advanced care planning, and housing decisions. The majority of articles focused on shared decision-making regarding health promotion for the patient (n = 16). Findings illustrate that shared decision-making requires deliberate effort and is preferred among family members, healthcare providers, and patients with dementia. Future research should include more robust efficacy testing of decision-making tools, incorporation of evidence-based shared decisionmaking approaches based on cognitive status/diagnosis, and consideration of geographical/cultural differences in healthcare delivery systems.
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Affiliation(s)
| | | | - Dan Wilson
- Health Sciences Library, 2358University of Virginia, USA
| | - Laura Jepson
- School of Nursing, 2358University of Virginia, USA
| | - Soojung Ahn
- School of Nursing, Vanderbilt University, USA
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Van Rickstal R, De Vleminck A, Engelborghs S, Van den Block L. Experiences with and perspectives on advance care planning in young- and late- onset dementia: A focus group study with physicians from various disciplines. Front Aging Neurosci 2023; 15:1130642. [PMID: 37056687 PMCID: PMC10088511 DOI: 10.3389/fnagi.2023.1130642] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/06/2023] [Indexed: 03/30/2023] Open
Abstract
IntroductionDespite the relevance of advance care planning (ACP) for people with dementia, its uptake in this population is particularly low. Several challenges for ACP in dementia have been identified from physicians’ perspectives. However, the literature available mainly includes general practitioners and focuses exclusively on the context of late-onset dementia. This is the first study to inquire physicians from four highly relevant specialisms in dementia care, with a focus toward potential specificities based on patients’ age. The research question of this study is: “What are physicians’ experiences with and perspectives on discussing ACP with people with young- and/or late-onset dementia?”.MethodsFive online focus groups were conducted with 21 physicians (general practitioners, psychiatrists, neurologists and geriatricians) in Flanders, Belgium. Verbatim transcripts were analyzed through the qualitative method of constant comparative analysis.ResultsPhysicians believed that the societal stigma related to dementia influences people’s reaction to their diagnosis, at times characterized by catastrophic expectations for the future. In this regard, they explained that the topic of euthanasia is sometimes addressed by patients very early in the disease trajectory. Respondents paid ample attention to actual end-of-life decisions, including DNR directives, when discussing ACP in dementia. Physicians felt responsible for providing accurate information on both dementia as a condition, and the legal framework of end-of-life decisions. Most participants felt that patients’ and caregivers’ wish for ACP was more driven by who their personality than by their age. Nonetheless, physicians identified specificities for a younger dementia population in terms of ACP: they believed that ACP covered more domains of life than for older persons. A high consistency regarding the viewpoints of physicians from differing specialisms was noted.DiscussionPhysicians acknowledge the added value of ACP for people with dementia and especially their caregivers. However, they face several challenges for engaging in the process. Attending to specific needs in young-onset, in comparison to late-onset dementia, requires ACP to entail more than solely medical domains. However, a medicalized view on ACP still appears to be dominant in practice as opposed to its broader conceptualization in academia.
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Affiliation(s)
- Romy Van Rickstal
- End-of-Life Care Research Group (VUB/UGhent), Brussels, Belgium
- Research Foundation—Flanders (FWO), Brussels, Belgium
- *Correspondence: Romy Van Rickstal,
| | - Aline De Vleminck
- End-of-Life Care Research Group (VUB/UGhent), Brussels, Belgium
- Research Foundation—Flanders (FWO), Brussels, Belgium
| | - Sebastiaan Engelborghs
- Department of Neurology, University Hospital Brussels, Brussels, Belgium
- Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Lieve Van den Block
- End-of-Life Care Research Group (VUB/UGhent), Brussels, Belgium
- Research Foundation—Flanders (FWO), Brussels, Belgium
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Odell-Miller H, Blauth L, Bloska J, Bukowska AA, Clark IN, Crabtree S, Engen RB, Knardal S, Kvamme TK, McMahon K, Petrowitz C, Smrokowska-Reichmann A, Stensæth K, Tamplin J, Wosch T, Wollersberger N, Baker FA. The HOMESIDE Music Intervention: A Training Protocol for Family Carers of People Living with Dementia. Eur J Investig Health Psychol Educ 2022; 12:1812-1832. [PMID: 36547028 PMCID: PMC9778265 DOI: 10.3390/ejihpe12120127] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/23/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
Background: The number of people living with dementia (PwD) worldwide is expected to double every 20 years. Many continue living at home, receiving support from family caregivers who may experience significant stress, simultaneously to that of the PwD. Meaningful and effective home-based interventions to support PwD and their caregivers are needed. The development of a theory- and practice-driven online home-based music intervention (MI) is delivered by credentialed music therapists, nested within the HOMESIDE RCT trial. Methods: Dyads including the PwD and their family carer are randomised to MI, reading (RI) or standard care (SC). MI aims to support health wellbeing and quality of life by training caregivers to intentionally use music (singing, instrument playing, movement/dancing, and music listening) with their family member (PwD) in daily routines. MI is underpinned by cognitive, relational, social, and psychological theories of mechanisms of change. Results: Preliminary sub-cohort results analyses show MI can be delivered and is accepted well by participants and music-therapist interventionists across five countries. Conclusions: The specialist skills of a music therapist through MI enable carers to access music when music therapists are not present, to meet carer and PwD needs. Music therapists embrace this changing professional role, observing therapeutic change for members of the dyads.
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Affiliation(s)
- Helen Odell-Miller
- Cambridge Institute for Music Therapy Research, Anglia Ruskin University, Cambridge CB1 1PT, UK
- Correspondence:
| | - Laura Blauth
- Music Therapy Lab, Institute for Applied Social Sciences, University of Applied Sciences Würzburg-Schweinfurt, 97072 Würzburg, Germany
| | - Jodie Bloska
- Cambridge Institute for Music Therapy Research, Anglia Ruskin University, Cambridge CB1 1PT, UK
| | - Anna A. Bukowska
- Institute of Applied Sciences, University of Physical Education in Krakow, 31-571 Krakow, Poland
| | - Imogen N. Clark
- Creative Arts and Music Therapy Research Unit, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Sarah Crabtree
- Cambridge Institute for Music Therapy Research, Anglia Ruskin University, Cambridge CB1 1PT, UK
| | - Runa B. Engen
- Centre for Research in Music and Health, Norwegian Academy of Music, 0369 Oslo, Norway
| | - Solgunn Knardal
- Centre for Research in Music and Health, Norwegian Academy of Music, 0369 Oslo, Norway
| | - Tone K. Kvamme
- Centre for Research in Music and Health, Norwegian Academy of Music, 0369 Oslo, Norway
| | - Kate McMahon
- Creative Arts and Music Therapy Research Unit, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Carina Petrowitz
- Music Therapy Lab, Institute for Applied Social Sciences, University of Applied Sciences Würzburg-Schweinfurt, 97072 Würzburg, Germany
| | | | - Karette Stensæth
- Centre for Research in Music and Health, Norwegian Academy of Music, 0369 Oslo, Norway
| | - Jeanette Tamplin
- Creative Arts and Music Therapy Research Unit, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Thomas Wosch
- Music Therapy Lab, Institute for Applied Social Sciences, University of Applied Sciences Würzburg-Schweinfurt, 97072 Würzburg, Germany
| | - Nina Wollersberger
- Cambridge Institute for Music Therapy Research, Anglia Ruskin University, Cambridge CB1 1PT, UK
| | - Felicity A. Baker
- Creative Arts and Music Therapy Research Unit, The University of Melbourne, Melbourne, VIC 3010, Australia
- Centre for Research in Music and Health, Norwegian Academy of Music, 0369 Oslo, Norway
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Dreyer J, Bergmann JM, Köhler K, Hochgraeber I, Pinkert C, Roes M, Thyrian JR, Wiegelmann H, Holle B. Differences and commonalities of home-based care arrangements for persons living with dementia in Germany - a theory-driven development of types using multiple correspondence analysis and hierarchical cluster analysis. BMC Geriatr 2022; 22:723. [PMID: 36050645 PMCID: PMC9438141 DOI: 10.1186/s12877-022-03310-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most persons with dementia live at home and want to stay there as long as possible. In most cases, informal carers such as spouses or children care for them. Together with other family members and professional carers, they form care arrangements to address the complex needs of persons with dementia. One major aim of informal carers is to keep the care arrangement stable. The middle-range theory of 'stability of home-based care arrangements for people living with dementia' (SoCA-Dem theory) offers a theory to understand what constitutes and influences the stability of home-based care arrangements. Based on this theory, the aim of this study was to (1) uncover the underlying structures of differences and commonalities of home-based care arrangements for persons living with dementia, (2) construct types of these care arrangements, and (3) compare these types with regard to their stability. METHOD This is a secondary analysis of data from a convenience sample of n = 320 care arrangements for persons with dementia obtained in the observational DemNet-D study. Data were analysed using multiple correspondence analysis and hierarchical cluster analysis. Sociodemographic data and variables related to the structure of the care arrangement (D-IVA), burden of the informal carer (BICS-D), dementia severity (FAST), and quality of life of the person with dementia (QOL-AD) were included. RESULTS The multiple correspondence analysis identified 27 axes that explained the entire variance between all care arrangements. The two axes 'dementia and care trajectory' and 'structure of the dyadic relationship' best distinguished care arrangements from each other and together explained 27.10% of the variance. The subsequent cluster analysis identified four types of care arrangements. Two types included spouse-centred care arrangements, and two types included child-centred care arrangements at different phases of the dementia and care trajectory. The types differ with regard to their stability. CONCLUSION The results highlight the heterogeneity and commonality of care arrangements for persons living with dementia. They contribute to a better understanding of informal dementia home care. Furthermore, the results can guide the development of tailored support for persons living with dementia and their caring families.
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Affiliation(s)
- Jan Dreyer
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Witten, Witten, Germany.
| | | | - Kerstin Köhler
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Witten, Witten, Germany
| | - Iris Hochgraeber
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Witten, Witten, Germany
| | - Christiane Pinkert
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Witten, Witten, Germany
| | - Martina Roes
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Witten, Witten, Germany
| | - Jochen René Thyrian
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Henrik Wiegelmann
- Institute for Public Health and Nursing Research, Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Bernhard Holle
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Witten, Witten, Germany
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Hart AS, Matthews AK, Arslanian-Engoren C, Patil CL, Krassa TJ, Bonner GJ. Experience of African American Surrogate Decision Makers of Patients With Dementia. J Hosp Palliat Nurs 2022; 24:84-94. [PMID: 34840282 DOI: 10.1097/njh.0000000000000822] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Dementia cases are expected to grow for African Americans and surrogate decision makers (SDMs) will have a significant role at the end of life (EOL). This qualitative exploratory case study used Cognitive Task Analysis and an integrated conceptual framework to understand the EOL decision experience of African American SDMs for patients with advanced dementia. Using a holistic multiple-case design, 8 African American SDMs were interviewed about their experiences with the decision-making process, including role acceptance, role enactment, and emotional outcomes of decision making. Thirteen themes germane to understanding the EOL decision experience of African American SDMs were identified. Findings suggest African American SDMs often lack sufficient knowledge of disease prognosis and intervention options to make informed treatment choices at EOL. In particular, African Americans extend the caregiver role to SDM for patients with dementia at EOL without being fully aware of the role and decision-making responsibilities. Surrogates lacked a general understanding of EOL options resulting in underutilization of hospice and palliative care and subsequent regret, and few interventions exist to improve the uptake of EOL care services. There is a need to develop culturally appropriate role preparation, education, and decision support to improve EOL treatment decisions and emotional adjustment of surrogates of patients with advanced dementia, which should be rendered early and throughout the illness trajectory.
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Harper AE, Terhorst L, Moscirella M, Turner RL, Piersol CV, Leland NE. The experiences, priorities, and perceptions of informal caregivers of people with dementia in nursing homes: A scoping review. DEMENTIA 2021; 20:2746-2765. [PMID: 33899537 DOI: 10.1177/14713012211012606] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Person-centered care has been shown to increase desired outcomes for people with dementia, yet informal caregivers' dissatisfaction with care is often reported. For those living in a nursing home, informal caregivers are uniquely situated to provide key insights into the individual's care. However, little is known of the informal caregivers' perspective, which hinders efforts to improve their satisfaction with person-centered nursing home care. Thus, we examined the comprehensive experiences, priorities, and perceptions of informal caregivers of nursing home residents with dementia. METHODS In collaboration with stakeholders, a scoping review of Medline (Ovid), EMBASE.com, CINAHL (EBSCO), the Cochrane Library (Wiley), and PsycINFO (Ovid) databases from January 2000 to July 2020 was conducted. Data were extracted reflecting the experiences, priorities, and preferences of caregivers of people with dementia residing in nursing homes. RESULTS We identified 114 articles that revealed nine themes: (1) communication, (2) transition to nursing home, (3) quality of care, (4) quality of life, (5) informal caregiver role, (6) knowledge of dementia, (7) end-of-life preferences, (8) medication use to manage neuropsychiatric behaviors, and (9) finances. CONCLUSION Informal caregivers described aspects of care that led to both positive and negative experiences with and perceptions of nursing home care. The shortcomings in communication were discussed most frequently, indicating a high priority area. While researchers define the identified themes individually, informal caregivers perceive them to be interwoven as they relate to person-centered care delivery. Although we did not assess the quality of included articles, by identifying themes relevant to caregivers' perspectives of nursing home care, our findings may help to inform efforts to optimize caregivers' satisfaction with nursing home care for residents with dementia.
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Affiliation(s)
- Alexandra E Harper
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Lauren Terhorst
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Marybeth Moscirella
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Rose L Turner
- Health Sciences Library System, 499478University of Pittsburgh, Pittsburgh, PA, USA
| | - Catherine V Piersol
- Department of Occupational Therapy, Jefferson College of Rehabilitation Sciences, 6559Thomas Jefferson University, Philadelphia, PA, USA
| | - Natalie E Leland
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, 6614University of Pittsburgh, Pittsburgh, PA, USA
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Köhler K, Dreyer J, Hochgraeber I, von Kutzleben M, Pinkert C, Roes M, Holle B. Towards a middle-range theory of 'Stability of home-based care arrangements for people living with dementia' (SoCA-Dem): findings from a meta-study on mixed research. BMJ Open 2021; 11:e042515. [PMID: 33853798 PMCID: PMC8054086 DOI: 10.1136/bmjopen-2020-042515] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Most people with dementia and their informal carers live at home and strive to create a stable care situation for as long as possible. This preference of dyads is consistent with the global policy of ageing in place. Therefore, we aimed to develop a middle-range theory of stability guided by two research questions: How is stability of home-based care arrangements for people living with dementia constituted? What are the essential factors influencing stability? METHODS Within the 'Stability of home-based care arrangements for people living with dementia' project (SoCA project) at the German Center for Neurodegenerative Diseases (DZNE), we conducted a meta-study on mixed research. The analytical steps of meta-data analysis, meta-method and meta-theory are merged in an integrative synthesis. Eligible publications were identified through systematic database searches (MEDLINE, CINAHL and PsycINFO; last searched on 3 January 2017), backward/forward citation tracking and snowballing. All publications were screened against predefined inclusion criteria and evaluated through a quality appraisal. The analytical approach was thematic synthesis. RESULTS 99 publications were included. The middle-range theory conceptualises stability as a complex phenomenon comprising three components including eight concepts that are dynamically inter-related. The conceptual model visualises: (1) the trajectory of the dementia care arrangement, which involves a cyclic process of change and balancing over time; (2) the characteristics of the care arrangement, including needs, the carer role, the dyadic relationship and resources; and (3) the context, which is determined by society and culture and the respective healthcare system. The relevance of each concept in relation to stability changes over time. The forming of each concept is actively shaped by the informal carer. DISCUSSION This middle-range theory provides a thorough understanding of the stability of home-based care arrangements for people living with dementia and can be used to guide future research and practice. OTHER This meta-study was funded by the DZNE and registered in PROSPERO (registration number CRD42016041727).
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Affiliation(s)
- Kerstin Köhler
- German Centre for Neurodegenerative Diseases (DZNE), Witten, Germany
- Faculty of Health, Department of Nursing Science, Witten/Herdecke University (UW/H), Witten, Germany
| | - Jan Dreyer
- German Centre for Neurodegenerative Diseases (DZNE), Witten, Germany
- Faculty of Health, Department of Nursing Science, Witten/Herdecke University (UW/H), Witten, Germany
| | - Iris Hochgraeber
- German Centre for Neurodegenerative Diseases (DZNE), Witten, Germany
- Faculty of Health, Department of Nursing Science, Witten/Herdecke University (UW/H), Witten, Germany
| | - Milena von Kutzleben
- Department of Health Services Research, School of Medicine and Health Sciences, University of Oldenburg, Oldenburg, Germany
| | - Christiane Pinkert
- German Centre for Neurodegenerative Diseases (DZNE), Witten, Germany
- Faculty of Health, Department of Nursing Science, Witten/Herdecke University (UW/H), Witten, Germany
| | - Martina Roes
- German Centre for Neurodegenerative Diseases (DZNE), Witten, Germany
- Faculty of Health, Department of Nursing Science, Witten/Herdecke University (UW/H), Witten, Germany
| | - Bernhard Holle
- German Centre for Neurodegenerative Diseases (DZNE), Witten, Germany
- Faculty of Health, Department of Nursing Science, Witten/Herdecke University (UW/H), Witten, Germany
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Lawani MA, Turgeon Y, Côté L, Légaré F, Witteman HO, Morin M, Kroger E, Voyer P, Rodriguez C, Giguere A. User-centered and theory-based design of a professional training program on shared decision-making with older adults living with neurocognitive disorders: a mixed-methods study. BMC Med Inform Decis Mak 2021; 21:59. [PMID: 33596874 PMCID: PMC7888116 DOI: 10.1186/s12911-021-01396-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 01/13/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND We know little about the best approaches to design training for healthcare professionals. We thus studied how user-centered and theory-based design contribute to the development of a distance learning program for professionals, to increase their shared decision-making (SDM) with older adults living with neurocognitive disorders and their caregivers. METHODS In this mixed-methods study, healthcare professionals who worked in family medicine clinics and homecare services evaluated a training program in a user-centered approach with several iterative phases of quantitative and qualitative evaluation, each followed by modifications. The program comprised an e-learning activity and five evidence summaries. A subsample assessed the e-learning activity during semi-structured think-aloud sessions. A second subsample assessed the evidence summaries they received by email. All participants completed a theory-based questionnaire to assess their intention to adopt SDM. Descriptive statistical analyses and qualitative thematic analyses were integrated at each round to prioritize training improvements with regard to the determinants most likely to influence participants' intention. RESULTS Of 106 participants, 98 completed their evaluations of either the e-learning activity or evidence summary (93%). The professions most represented were physicians (60%) and nurses (15%). Professionals valued the e-learning component to gain knowledge on the theory and practice of SDM, and the evidence summaries to apply the knowledge gained through the e-learning activity to diverse clinical contexts. The iterative design process allowed addressing most weaknesses reported. Participants' intentions to adopt SDM and to use the summaries were high at baseline and remained positive as the rounds progressed. Attitude and social influence significantly influenced participants' intention to use the evidence summaries (P < 0.0001). Despite strong intention and the tailoring of tools to users, certain factors external to the training program can still influence the effective use of these tools and the adoption of SDM in practice. CONCLUSIONS A theory-based and user-centered design approach for continuing professional development interventions on SDM with older adults living with neurocognitive disorders and their caregivers appeared useful to identify the most important determinants of learners' intentions to use SDM in their practice, and validate our initial interpretations of learners' assessments during the subsequent evaluation round.
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Affiliation(s)
- Moulikatou Adouni Lawani
- Laval University, Pavillon Ferdinand-Vandry, Room 2881, 1050 avenue de la Médecine, Quebec, QC G1V 0A6 Canada
| | - Yves Turgeon
- CISSS de la Gaspésie – Service externe de gériatrie ambulatoire, 455 rue Mgr Ross Est, Chandler, QC G0C 1K0 Canada
| | - Luc Côté
- Laval University, Pavillon Ferdinand-Vandry, Room 1323, 1050 avenue de la Médecine, Quebec, QC G1V 0A6 Canada
| | - France Légaré
- VITAM Research Centre on Sustainable Health, Pavillon Landry-Poulin, Pavillon Landry-Poulin, Door A-1-2, 4th floor, Room 4578, 2525 Chemin de la Canardière, Québec, QC G1J 0A4 Canada
| | - Holly O. Witteman
- Laval University, Pavillon Ferdinand-Vandry, Room 2881, 1050 avenue de la Médecine, Quebec, QC G1V 0A6 Canada
| | - Michèle Morin
- Laval University, Pavillon Ferdinand-Vandry, room 4211, 1050 avenue de la Médecine, Quebec, QC G1V 0A6 Canada
| | - Edeltraut Kroger
- Quebec Excellence Centre in Aging, St-Sacrement Hospital, 1050 chemin Ste-Foy, Quebec, QC G1S 4L8 Canada
| | - Philippe Voyer
- Pavillon Ferdinand-Vandry, Room 3445, 1050 avenue de la Médecine, Quebec, QC G1V 0A6 Canada
| | - Charo Rodriguez
- Departmentof Family Medicine, McGill University, 5858 chemin de la Côte-des-Neiges, 3rd floor, Montreal, QC H3S 1Z1 Canada
| | - Anik Giguere
- VITAM Research Centre on Sustainable Health, Pavillon Landry-Poulin, Door A-1-2, 2nd floor, Room 2416, 2525 Chemin de la Canardière, Québec, QC G1J 0A4 Canada
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11
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Clark IN, Stretton-Smith PA, Baker FA, Lee YEC, Tamplin J. "It's Feasible to Write a Song": A Feasibility Study Examining Group Therapeutic Songwriting for People Living With Dementia and Their Family Caregivers. Front Psychol 2020; 11:1951. [PMID: 32849143 PMCID: PMC7426520 DOI: 10.3389/fpsyg.2020.01951] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/14/2020] [Indexed: 12/30/2022] Open
Abstract
Background Psychosocial interventions for people with dementia and their family caregivers together may sustain relationship quality and social connection. No previous music therapy research has examined the effects of group therapeutic songwriting (TSW) attended by people with dementia/family caregiver dyads. Methods This pre-post feasibility study aimed to examine the acceptability of a group TSW intervention for people with dementia/family caregiver dyads and test the sensitivity of the following outcomes: Quality of the Caregiver-Patient Relationship (QCPR, primary); Cornell Scale for Depression in Dementia (CSDD) and Quality of Life-Alzheimer's Dementia for people with dementia, Patient Health Questionnaire-9, Assessment of Quality of Life-8 Dimensions (AQoL-8D); and Zarit Burden Interview for family caregivers. Six weekly 1 h sessions guided participants to identify preferred music, brainstorm ideas, create lyrics, and record songs. Qualitative interviews were conducted with dyads who completed the intervention. Results Fourteen dyads were recruited and completed baseline assessments. Participants with dementia were aged 62-92 years (M = 77, SD = 11). Caregiver participants (11 spouses, two daughters, one son) were aged 54-92 years (M = 67, SD = 10.1). Four dyads withdrew owing to declining health or inconvenience before the program commenced (n = 2) and after attending 1-2 sessions (n = 2). Ten dyads formed four homogeneous TSW groups (71% completion). No statistically significant changes were detected for any measure. High QCPR ratings at baseline (M = 57.1) and follow-up (M = 57.4) demonstrated sustained relationship quality. For participants with dementia, large effect sizes for the CSDD suggested trends toward decreased depression (d = -0.83) and improved mood (d = -0.88). For family caregivers, a large effect size suggested a trend toward improvement for the AQoL-8D sub-domain examining independent living (d = -0.93). Qualitative data indicated that session design and delivery were acceptable, and TSW was a positive shared experience with personal benefits, which supported rather than changed relationship quality. Conclusion High retention and qualitative data indicate that TSW was well received by participants. Effect sizes suggest that group TSW for dyads may have beneficial impacts on depression for people with dementia and quality of life for family caregivers. Future research with a fully powered sample is recommended to further examine the psychosocial impacts of group TSW for people living with dementia/family caregiver dyads.
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Affiliation(s)
- Imogen N Clark
- Melbourne Conservatorium of Music, Faculty of Fine Arts and Music, University of Melbourne, Melbourne, VIC, Australia
| | - Phoebe A Stretton-Smith
- Melbourne Conservatorium of Music, Faculty of Fine Arts and Music, University of Melbourne, Melbourne, VIC, Australia
| | - Felicity A Baker
- Melbourne Conservatorium of Music, Faculty of Fine Arts and Music, University of Melbourne, Melbourne, VIC, Australia
| | - Young-Eun C Lee
- Melbourne Conservatorium of Music, Faculty of Fine Arts and Music, University of Melbourne, Melbourne, VIC, Australia
| | - Jeanette Tamplin
- Melbourne Conservatorium of Music, Faculty of Fine Arts and Music, University of Melbourne, Melbourne, VIC, Australia
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12
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Garvelink MM, Groen-van de Ven L, Smits C, Franken R, Dassen-Vernooij M, Légaré F. Shared Decision Making About Housing Transitions for Persons With Dementia: A Four-Case Care Network Perspective. THE GERONTOLOGIST 2020; 59:822-834. [PMID: 30007366 DOI: 10.1093/geront/gny073] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Persons with dementia (PWDs) and their caregivers often face difficult housing decisions, that is, decisions about their living arrangements, in which the perspectives of all members of the care network should be involved. OBJECTIVE We performed a qualitative data analysis to assess the extent to which housing decisions for PWDs with their formal and informal caregivers correspond to an interprofessional shared decision making (IP-SDM) approach, and what light this approach sheds on their experiences with decision making. RESEARCH DESIGN AND METHODS We used the IP-SDM model to content-code and analyze data from 4 care networks, each consisting of a PWD, 2 informal and 2 formal caregivers. RESULTS Decision making in all networks corresponded to most IP-SDM elements, but never included all network members. Decision making was guided by the wishes of the PWD, but their actual involvement decreased over time. DISCUSSION Results show that while the IP-SDM model was helpful, the options change with cognitive decline and moving to a nursing home can become inevitable in spite of preferences. IMPLICATIONS Timely and honest communication helps to mitigate the distress of deciding against patient preferences, as could advance care planning about future housing transitions.
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Affiliation(s)
- Mirjam Marjolein Garvelink
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Québec, Canada.,IQ Healthcare, Radboud UMC, Nijmegen, the Netherlands
| | | | - Carolien Smits
- Windesheim University of Applied Sciences, Zwolle, the Netherlands
| | - Rob Franken
- IQ Healthcare, Radboud UMC, Nijmegen, the Netherlands
| | | | - France Légaré
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Québec, Canada
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13
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Bhatt J, Walton H, Stoner CR, Scior K, Charlesworth G. The nature of decision-making in people living with dementia: a systematic review. Aging Ment Health 2020; 24:363-373. [PMID: 30521371 DOI: 10.1080/13607863.2018.1544212] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: The objectives of this systematic review were to: 1) understand how people living with dementia are involved in making decisions; 2) explore the different decisional styles and domains of decision-making that people living with dementia experience and 3) identify what influences the level of decisional involvement of people living with dementia.Methods: A systematic review of literature identified studies from Medline, PsycINFO, HAPI and CINAHL databases. Search terms related to decision-making and dementia. Qualitative and quantitative research designs were included. Appraisal of included studies was done using quality ratings. All studies focused on how decision-making took place. Extracted findings were synthesised narratively with concept mapping, conceptualisation and an exploration of connections between studies to develop an overall model of decision-making involvementResults: Fifteen studies fully met the eligibility criteria (thirteen qualitative and two quantitative). All studies had moderate (n = 10) to high (n = 5) quality ratings. Participants were predominantly people living with dementia (n = 13), Parkinson's disease and stroke. The model of decision-making encompasses four decisional styles (managed autonomy, mutual, reductive and delegated) determined by different degrees of involvement from the person living with dementia and their supporter. The decisional style implemented was influenced by the presence or absence of background (the Freedom of Choice framework) and contextual factors (risk, relationships and resources).Conclusion: Decision-making in dementia is complex and influenced by many factors beyond cognitive impairment alone. This review indicates that decision-making in dementia takes place through decisional styles, determined by unique levels of involvement from people living with dementia and their carers.
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Affiliation(s)
- Jem Bhatt
- Research Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, London, UK
| | - Holly Walton
- Research Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, London, UK
| | - Charlotte R Stoner
- Research Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, London, UK
| | - Katrina Scior
- Research Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, London, UK
| | - Georgina Charlesworth
- Research Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, London, UK
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14
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Van Rickstal R, De Vleminck A, Aldridge MD, Morrison SR, Koopmans RT, van der Steen JT, Engelborghs S, Van den Block L. Limited engagement in, yet clear preferences for advance care planning in young-onset dementia: An exploratory interview-study with family caregivers. Palliat Med 2019; 33:1166-1175. [PMID: 31342861 DOI: 10.1177/0269216319864777] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The significance of advance care planning in dementia is widely acknowledged. Despite the suggestion that younger people with dementia and their family might have distinct needs and preferences in this area, studies on advance care planning in young-onset dementia are absent. AIM We aim to explore (1) whether family caregivers had already engaged in advance care planning with patients and/ or professionals and the accompanying reasons and (2) family caregivers' preferences for how to ideally engage in the process with patients, family and professionals. DESIGN A qualitative study was conducted: we analysed semi-structured interviews (n = 15) through the method of constant comparative analysis. SETTING/PARTICIPANTS We included Flemish family caregivers of persons with young-onset dementia. RESULTS Plans for the future typically concerned non-medical affairs. Participants' limited engagement in advance care planning was clarified through several reasons: not considering it useful, hindering patient behaviour, adopting a day-to-day attitude, caregivers emotionally protecting themselves and uncertainty about patients' cognitive competence. However, endorsement for advance care planning showed from respondents' preferences that it should be initiated timely, by a third party, and emphasize patients' remaining capacities. Finally, the need for information and high-quality care emerged. CONCLUSION A gap of knowledge, of information and in care intertwiningly hinder advance care planning. In young-onset dementia, engaging in advance care planning is not an option equally accessible as not doing so. Policy makers, institutions and professionals could reflect on their responsibility in providing these patients and caregivers an actual choice to engage in advance care planning or not.
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Affiliation(s)
- Romy Van Rickstal
- Department of Family Medicine and Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Aline De Vleminck
- Department of Family Medicine and Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Melissa D Aldridge
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,James J. Peters Veterans Affairs Medical Center, New York, NY, USA
| | - Sean R Morrison
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,James J. Peters Veterans Affairs Medical Center, New York, NY, USA
| | - Raymond T Koopmans
- Department of Primary and Community Care, Radboud Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands.,Joachim and Anna, Centre for Specialized Geriatric Care, Nijmegen, The Netherlands
| | - Jenny T van der Steen
- Department of Primary and Community Care, Radboud Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Sebastiaan Engelborghs
- Institute Born-Bunge, University of Antwerp, Antwerp, Belgium.,Department of Neurology, UZ Brussel, Brussels, Belgium and Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Lieve Van den Block
- Department of Family Medicine and Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
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15
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Abstract
UNLABELLED ABSTRACTObjectives:Dementia often limits the agency of the person to such an extent that there is need for external support in making daily life decisions. This support is usually provided by family members who are sometimes legally empowered to engage in decision-making on behalf of the person for whom they care. However, such family carers receive little or no information on how to best provide support when there is a lack of capacity. This may have an impact on the agency of the person with dementia. This review explores the experience of agency in people living with dementia. DESIGN A systematic search was conducted on IBSS, MedLine, PsychINFO, EMBASE, and CINAHL. Two independent researchers screened the studies and conducted the quality appraisal. We used meta-ethnography for data analysis. As part of the synthesis, we identified behavioral mechanisms underlying the process of decision-making and looked at how the support of carers comes into play in making deliberate choices. RESULTS The meta-ethnography involved 20 studies. Three levels of third-order constructs were identified, each describing a decision-making pathway and reflecting the degree of autonomy of the person with dementia: autonomous decision-making, shared decision-making, and pseudo decision-making. Findings highlight those inter-relational processes that promote or negatively impact on the agency of people with dementia. CONCLUSIONS Our review will provide health and social care personnel with an understanding of the role of the carer in the decision-making process, and therefore which mechanisms need to be promoted or discouraged through training.
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16
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Sellars M, Chung O, Nolte L, Tong A, Pond D, Fetherstonhaugh D, McInerney F, Sinclair C, Detering KM. Perspectives of people with dementia and carers on advance care planning and end-of-life care: A systematic review and thematic synthesis of qualitative studies. Palliat Med 2019; 33:274-290. [PMID: 30404576 PMCID: PMC6376607 DOI: 10.1177/0269216318809571] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND: Advance care planning aims to ensure that care received during serious and chronic illness is consistent with the person’s values, preferences and goals. However, less than 40% of people with dementia undertake advance care planning internationally. AIM: This study aims to describe the perspectives of people with dementia and their carers on advance care planning and end-of-life care. DESIGN: Systematic review and thematic synthesis of qualitative studies. DATA SOURCES: Electronic databases were searched from inception to July 2018. RESULTS: From 84 studies involving 389 people with dementia and 1864 carers, five themes were identified: avoiding dehumanising treatment and care (remaining connected, delaying institutionalisation, rejecting the burdens of futile treatment); confronting emotionally difficult conversations (signifying death, unpreparedness to face impending cognitive decline, locked into a pathway); navigating existential tensions (accepting inevitable incapacity and death, fear of being responsible for cause of death, alleviating decisional responsibility); defining personal autonomy (struggling with unknown preferences, depending on carer advocacy, justifying treatments for health deteriorations); and lacking confidence in healthcare settings (distrusting clinicians’ mastery and knowledge, making uninformed choices, deprived of hospice access and support at end of life). CONCLUSION: People with dementia and their carers felt uncertain in making treatment decisions in the context of advance care planning and end-of-life care. Advance care planning strategies that attend to people’s uncertainty in decision-making may help to empower people with dementia and carers and strengthen person-centred care in this context.
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Affiliation(s)
- Marcus Sellars
- 1 Advance Care Planning Australia, Austin Health, Melbourne, VIC, Australia.,2 Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Olivia Chung
- 1 Advance Care Planning Australia, Austin Health, Melbourne, VIC, Australia
| | - Linda Nolte
- 1 Advance Care Planning Australia, Austin Health, Melbourne, VIC, Australia
| | - Allison Tong
- 3 Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Dimity Pond
- 4 School of Medicine and Public Health (General Practice), The University of Newcastle, Callaghan, NSW, Australia
| | - Deirdre Fetherstonhaugh
- 5 Australian Centre for Evidence Based Aged Care, La Trobe University, Melbourne, VIC, Australia
| | - Fran McInerney
- 6 Wicking Dementia Research and Education Centre, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Craig Sinclair
- 7 Rural Clinical School of Western Australia, University of Western Australia, Albany, WA, Australia
| | - Karen M Detering
- 1 Advance Care Planning Australia, Austin Health, Melbourne, VIC, Australia.,8 Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, VIC, Australia
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17
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Dreyer J, Köhler K, Hochgraeber I, Holle B, von Kutzleben M. Stability of home-based care arrangements for people living with dementia: protocol of a meta-study on mixed research. BMJ Open 2018; 8:e021156. [PMID: 30056381 PMCID: PMC6067342 DOI: 10.1136/bmjopen-2017-021156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Worldwide, most people with dementia live at home and are cared for by informal carers. During the dementia care trajectory, creating and maintaining a stable care situation is a guiding principle of informal carers and a desirable outcome of contemporary healthcare policies. However, though there is an extensive body of research focusing on the course of dementia care trajectories, it remains unclear how stability of home-based care arrangements is constituted and what are the essential factors that influence this stability. This paper outlines a protocol of a systematic review that aims to address these gaps in knowledge. METHODS AND ANALYSIS To theorise the complex phenomenon of stability of home-based care arrangements for people with dementia, we will conduct a meta-study. Meta-studies include three analytical components (meta-data analysis, meta-method and meta-theory) that are combined and finally culminate in an integrative knowledge synthesis. Originally, meta-study was designed to include qualitative studies only. To capture relevant contributions to our target phenomenon from all types of evidence, we will extend the original methodology and apply it to studies with qualitative, quantitative and mixed-methods designs and to (systematic) reviews. Eligible studies will be identified by systematic database searches (PubMed, CINAHL and PsycINFO), backward/forward citation tracking, snowballing and theoretical sampling. All identified studies will be screened against predefined inclusion criteria. The main analytical approach for all analyses is thematic synthesis. The meta-study will generate a more comprehensive understanding of dementia care trajectories and will be used to identify research gaps, develop future research questions and define relevant outcomes. DISSEMINATION The findings of the meta-study will be published in a series of articles in peer-reviewed scientific journals and will be presented at national and international scientific conferences. PROSPERO REGISTRATION NUMBER CRD42016041727.
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Affiliation(s)
- Jan Dreyer
- German Center for Neurodegenerative Diseases (DZNE) Site Witten, Witten, Germany
- Department of Health, School of Nursing Science, Witten/Herdecke University, Witten, Germany
| | - Kerstin Köhler
- German Center for Neurodegenerative Diseases (DZNE) Site Witten, Witten, Germany
- Department of Health, School of Nursing Science, Witten/Herdecke University, Witten, Germany
| | - Iris Hochgraeber
- German Center for Neurodegenerative Diseases (DZNE) Site Witten, Witten, Germany
- Department of Health, School of Nursing Science, Witten/Herdecke University, Witten, Germany
| | - Bernhard Holle
- German Center for Neurodegenerative Diseases (DZNE) Site Witten, Witten, Germany
- Department of Health, School of Nursing Science, Witten/Herdecke University, Witten, Germany
| | - Milena von Kutzleben
- German Center for Neurodegenerative Diseases (DZNE) Site Witten, Witten, Germany
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18
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Giguere AMC, Lawani MA, Fortier-Brochu É, Carmichael PH, Légaré F, Kröger E, Witteman HO, Voyer P, Caron D, Rodríguez C. Tailoring and evaluating an intervention to improve shared decision-making among seniors with dementia, their caregivers, and healthcare providers: study protocol for a randomized controlled trial. Trials 2018; 19:332. [PMID: 29941020 PMCID: PMC6019313 DOI: 10.1186/s13063-018-2697-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 05/17/2018] [Indexed: 11/13/2022] Open
Abstract
Background The increasing prevalence of Alzheimer’s disease and other forms of dementia raises new challenges to ensure that healthcare decisions are informed by research evidence and reflect what is important for seniors and their caregivers. Therefore, we aim to evaluate a tailored intervention to help healthcare providers empower seniors and their caregivers in making health-related decisions. Methods In two phases, we will: (1) design and tailor the intervention; and (2) implement and evaluate it. We will use theory and user-centered design to tailor an intervention comprising a distance professional training program on shared decision-making and five shared decision-making tools dealing with difficult decisions often faced by seniors with dementia and their caregivers. Each tool will be designed in two versions, one for clinicians and one for patients. We will recruit 49 clinicians and 27 senior/caregiver to participate in three cycles of design-evaluation-feedback of each intervention components. Besides think-aloud and interview approaches, users will also complete questionnaires based on the Theory of Planned Behavior to identify the factors most likely to influence their adoption of shared decision-making after exposure to the intervention. We will then modify the intervention by adding/enhancing behavior-change techniques targeting these factors. We will evaluate the effectiveness of this tailored intervention before/after implementation, in a two-armed, clustered randomized trial. We will enroll a convenience sample of six primary care clinics (unit of randomization) in the province of Quebec and recruit the clinicians who practice there (mostly family physicians, nurses, and social workers). These clinics will then be randomized to immediate exposure to the intervention or delayed exposure. Overall, we will recruit 180 seniors with dementia, their caregivers, and their healthcare providers. We will evaluate the impact of the intervention on patient involvement in the decision-making process, decisional comfort, patient and caregiver personal empowerment in relation to their own healthcare, patient quality of life, caregiver burden, and decisional regret. Discussion The intervention will empower patients and their caregivers in their healthcare, by fostering their participation as partners during the decision-making process and by ensuring they make informed decisions congruent with their values and priorities. Trial registration ClinicalTrials.org, NCT02956694. Registered on 31 October 2016. Electronic supplementary material The online version of this article (10.1186/s13063-018-2697-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anik M C Giguere
- Department of Family Medicine and Emergency Medicine, Laval University, Pavillon Ferdinand-Vandry, room 2881-C, 1050 avenue de la Médecine, Quebec, QC, G1V 0A6, Canada. .,Quebec Centre for Excellence on Aging, St-Sacrement Hospital, Room L2-21, 1050, chemin Sainte-Foy, Quebec City, Quebec, Canada. .,Laval University Research Centre on Primary Care and Services, Quebec City, Quebec, Canada. .,Research Axis of Population Health and Practice-Changing Research Group, CHU de Quebec Research Centre, Quebec city, QC, Canada.
| | - Moulikatou Adouni Lawani
- Department of Family Medicine and Emergency Medicine, Laval University, Pavillon Ferdinand-Vandry, room 2881-C, 1050 avenue de la Médecine, Quebec, QC, G1V 0A6, Canada.,Quebec Centre for Excellence on Aging, St-Sacrement Hospital, Room L2-21, 1050, chemin Sainte-Foy, Quebec City, Quebec, Canada.,Laval University Research Centre on Primary Care and Services, Quebec City, Quebec, Canada
| | - Émilie Fortier-Brochu
- Department of Family Medicine and Emergency Medicine, Laval University, Pavillon Ferdinand-Vandry, room 2881-C, 1050 avenue de la Médecine, Quebec, QC, G1V 0A6, Canada.,Quebec Centre for Excellence on Aging, St-Sacrement Hospital, Room L2-21, 1050, chemin Sainte-Foy, Quebec City, Quebec, Canada.,Laval University Research Centre on Primary Care and Services, Quebec City, Quebec, Canada
| | - Pierre-Hugues Carmichael
- Quebec Centre for Excellence on Aging, St-Sacrement Hospital, Room L2-21, 1050, chemin Sainte-Foy, Quebec City, Quebec, Canada
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Laval University, Pavillon Ferdinand-Vandry, room 2881-C, 1050 avenue de la Médecine, Quebec, QC, G1V 0A6, Canada.,Faculty of Nursing Sciences, Laval University, Pavillon Ferdinand-Vandry, room 2881-C, 1050, avenue de la Médecine, Quebec, QC, G1V 0A6, Canada
| | - Edeltraut Kröger
- Quebec Centre for Excellence on Aging, St-Sacrement Hospital, Room L2-21, 1050, chemin Sainte-Foy, Quebec City, Quebec, Canada.,Research Axis of Population Health and Practice-Changing Research Group, CHU de Quebec Research Centre, Quebec city, QC, Canada.,Faculty of Pharmacy, Laval University, St-Sacrement Hospital, Room L2-30, 1050, Chemin Sainte-Foy, Québec, QC, G1S 4L8, Canada
| | - Holly O Witteman
- Department of Family Medicine and Emergency Medicine, Laval University, Pavillon Ferdinand-Vandry, room 2881-C, 1050 avenue de la Médecine, Quebec, QC, G1V 0A6, Canada.,Quebec Centre for Excellence on Aging, St-Sacrement Hospital, Room L2-21, 1050, chemin Sainte-Foy, Quebec City, Quebec, Canada.,Research Axis of Population Health and Practice-Changing Research Group, CHU de Quebec Research Centre, Quebec city, QC, Canada
| | - Philippe Voyer
- Quebec Centre for Excellence on Aging, St-Sacrement Hospital, Room L2-21, 1050, chemin Sainte-Foy, Quebec City, Quebec, Canada.,Faculty of Nursing Sciences, Laval University, Pavillon Ferdinand-Vandry, room 2881-C, 1050, avenue de la Médecine, Quebec, QC, G1V 0A6, Canada
| | - Danielle Caron
- Department of Family Medicine and Emergency Medicine, Laval University, Pavillon Ferdinand-Vandry, room 2881-C, 1050 avenue de la Médecine, Quebec, QC, G1V 0A6, Canada
| | - Charo Rodríguez
- Department of Family Medicine, Faculty of Medicine, McGill University, 5858 chemin de la Cote-des-Neiges, 3rd floor, Suite 300, Room 328, Montreal, Quebec, Canada
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19
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Groen-van de Ven L, Smits C, de Graaff F, Span M, Eefsting J, Jukema J, Vernooij-Dassen M. Involvement of people with dementia in making decisions about their lives: a qualitative study that appraises shared decision-making concerning daycare. BMJ Open 2017; 7:e018337. [PMID: 29133329 PMCID: PMC5695519 DOI: 10.1136/bmjopen-2017-018337] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To explore how people with dementia, their informal caregivers and their professionals participate in decision making about daycare and to develop a typology of participation trajectories. DESIGN A qualitative study with a prospective, multiperspective design, based on 244 semistructured interviews, conducted during three interview rounds over the course of a year. Analysis was by means of content analysis and typology construction. SETTING Community settings and nursing homes in the Netherlands. PARTICIPANTS 19 people with dementia, 36 of their informal caregivers and 38 of their professionals (including nurses, daycare employees and case managers). RESULTS The participants' responses related to three critical points in the decision-making trajectory about daycare: (1) the initial positive or negative expectations of daycare; (2) negotiation about trying out daycare by promoting, resisting or attuning to others; and (3) trying daycare, which resulted in positive or negative reactions from people with dementia and led to a decision. The ways in which care networks proceeded through these three critical points resulted in a typology of participation trajectories, including (1) working together positively toward daycare, (2) bringing conflicting perspectives together toward trying daycare and (3) not reaching commitment to try daycare. CONCLUSION Shared decision making with people with dementia is possible and requires and adapted process of decision making. Our results show that initial preferences based on information alone may change when people with dementia experience daycare. It is important to have a try-out period so that people with dementia can experience daycare without having to decide whether to continue it. Whereas shared decision making in general aims at moving from initial preferences to informed preferences, professionals should focus more on moving from initial preferences to experienced preferences for people with dementia. Professionals can play a crucial role in facilitating the possibilities for a try-out period.
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Affiliation(s)
- Leontine Groen-van de Ven
- Research Group Innovating with Older Adults, Windesheim University of Applied Sciences, Zwolle, The Netherlands
| | - Carolien Smits
- Research Group Innovating with Older Adults, Windesheim University of Applied Sciences, Zwolle, The Netherlands
| | - Fuusje de Graaff
- MUTANT Agency for Diversity and Change, The Hague, The Netherlands
| | - Marijke Span
- ProMemo Expertise Centre for Professionals in Dementia Care, WindesheimUniversity of Applied Sciences, Zwolle, The Netherlands
| | - Jan Eefsting
- Department of Nursing Home Medicine, VU University Medical Centre, Amsterdam, The Netherlands
| | - Jan Jukema
- Research Group Innovating with Older Adults, Windesheim University of Applied Sciences, Zwolle, The Netherlands
| | - Myrra Vernooij-Dassen
- Radboud University Nijmegen Medical Centre, Scientific Institute for Quality of Healthcare and Nijmegen Alzheimer Centre, Nijmegen, The Netherlands
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20
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Chen L. Power and ambivalence in intergenerational communication: Deciding to institutionalize in Shanghai. J Aging Stud 2017; 41:44-51. [DOI: 10.1016/j.jaging.2017.03.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 03/13/2017] [Accepted: 03/31/2017] [Indexed: 01/18/2023]
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