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Thi-Thu Doan T, Kim J, Kim H, An W, Seo E, Park M. Decision Regret and Decision-Making Process Among Caregivers of Older Adults Receiving Home Care: A Cross-Sectional Study. J Am Med Dir Assoc 2024:105166. [PMID: 39043248 DOI: 10.1016/j.jamda.2024.105166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 06/11/2024] [Accepted: 06/14/2024] [Indexed: 07/25/2024]
Abstract
OBJECTIVES Family caregivers of older adults receiving home care often find themselves in situations in which they must make important and difficult decisions, which can cause conflict and regret. To tailor shared decision making in this context, we aimed to identify the most difficult decisions they faced, assess their levels of decision regret, and explore the associated factors. DESIGN This study used a cross-sectional design. SETTING AND PARTICIPANTS Participants included 165 caregivers of older adults who received home care services in Korea. METHODS We identified difficult decisions perceived by family caregivers of older adults and evaluated decision regret using the Decision Regret Scale (DRS), decisional conflict using the Decisional Conflict Scale (DCS), burden of care using the Short Zarit Burden Inventory, and Preference Control Scale (PCS). We then performed descriptive, bivariate, and multivariate linear regression analyses to identify factors predicting decision regret. RESULTS The most frequently reported difficult decisions were related to place of living (71.6%), management of health conditions (15.1%), and end-of-life decisions (13.3%). The mean DCS score was 37.09 (12.67), the DRS score was 32.33 (15.91), and the burden score was 21.81 (8.25). Matching decisions with preferences and aligning decision-making roles significantly reduced regret, while decision conflicts increased regret. CONCLUSIONS AND IMPLICATIONS The positive associations between decision regret, decision conflict, and the alignment of decision-making roles highlight the intricate dynamics involved in the decision-making process for family caregivers. These findings emphasize the need for tailored interventions that recognize and address the diverse factors influencing caregivers' decision-making experiences. Future research exploring the efficacy of targeted interventions such as decision-support programs or caregiver education initiatives could offer valuable insights into mitigating decision-related challenges and improving the overall well-being of both caregivers and care recipients.
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Affiliation(s)
- Thao Thi-Thu Doan
- CNU Community Care Center, College of Nursing, Chungnam National University, Daejeon, Republic of Korea; Faculty of Nursing, Hai Phong University of Medicine and Pharmacy, Haiphong, Vietnam
| | - Jinju Kim
- CNU Community Care Center, College of Nursing, Chungnam National University, Daejeon, Republic of Korea
| | - Heejung Kim
- CNU Community Care Center, College of Nursing, Chungnam National University, Daejeon, Republic of Korea
| | - Wonmi An
- CNU Community Care Center, College of Nursing, Chungnam National University, Daejeon, Republic of Korea
| | - Eunkyung Seo
- CNU Community Care Center, College of Nursing, Chungnam National University, Daejeon, Republic of Korea
| | - Myonghwa Park
- CNU Community Care Center, College of Nursing, Chungnam National University, Daejeon, Republic of Korea.
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Tschoe M, Murawski A, Miller A, Relerford R, Ramirez-Zohfeld V, Petrakos A, Lindquist LA. Aging-in-place versus long-term care conflicts experienced by older adults. J Am Geriatr Soc 2024. [PMID: 38777344 DOI: 10.1111/jgs.19012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 04/25/2024] [Accepted: 04/29/2024] [Indexed: 05/25/2024]
Affiliation(s)
- Marianne Tschoe
- Division of Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Alaine Murawski
- Division of Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Amber Miller
- Division of Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Raven Relerford
- Division of Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Vanessa Ramirez-Zohfeld
- Division of Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Alexandra Petrakos
- Division of Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Lee A Lindquist
- Division of Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Wen FH, Hsieh CH, Su PJ, Shen WC, Hou MM, Chou WC, Chen JS, Chang WC, Tang ST. Factors Associated With Family Surrogate Decisional-Regret Trajectories. J Pain Symptom Manage 2024; 67:223-232.e2. [PMID: 38036113 DOI: 10.1016/j.jpainsymman.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/09/2023] [Accepted: 11/17/2023] [Indexed: 12/02/2023]
Abstract
CONTEXT/OBJECTIVES The scarce research on factors associated with surrogate decisional regret overlooks longitudinal, heterogenous decisional-regret experiences and fractionally examines factors from the three decision-process framework stages: decision antecedents, decision-making process, and decision outcomes. This study aimed to fill these knowledge gaps by focusing on factors modifiable by high-quality end-of-life (EOL) care. METHODS This observational study used a prior cohort of 377 family surrogates of terminal-cancer patients to examine factors associated with their membership in the four preidentified distinct decisional-regret trajectories: resilient, delayed-recovery, late-emerging, and increasing-prolonged trajectories from EOL-care decision making through the first two bereavement years by multinomial logistic regression modeling using the resilient trajectory as reference. RESULTS Decision antecedent factors: Financial sufficiency and heavier caregiving burden increased odds for the delayed-recovery trajectory. Spousal loss, higher perceived social support during an EOL-care decision, and more postloss depressive symptoms increased odds for the late-emerging trajectory. More pre- and postloss depressive symptoms increased odds for the increasing-prolonged trajectory. Decision-making process factors: Making an anticancer treatment decision and higher decision conflict increased odds for the delayed-recovery and increasing-prolonged trajectories. Making a life-sustaining-treatment decision increased membership in the three more profound trajectories. Decision outcome factors: Greater surrogate appraisal of quality of dying and death lowered odds for the three more profound trajectories. Patient receipt of anticancer or life-sustaining treatments increased odds for the late-emerging trajectory. CONCLUSION Surrogate membership in decisional-regret trajectories was associated with decision antecedent, decision-making process, and decision outcome factors. Effective interventions should target identified modifiable factors to address surrogate decisional regret.
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Affiliation(s)
- Fur-Hsing Wen
- Department of International Business (F.H.W.), Soochow University, Taipei, Taiwan
| | - Chia-Hsun Hsieh
- College of Medicine (C.H.H., W.C.C., J.S.C., W.C.C.), Chang Gung University, Tao-Yuan, Taiwan; Division of Hematology-Oncology (C.H.H.), Department of Internal Medicine, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan
| | - Po-Jung Su
- Division of Hematology-Oncology (P.J.S., W.C.S., M.M.H., W.C.C., J.S.C., W.C.C., S.T.T.), Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
| | - Wen-Chi Shen
- Division of Hematology-Oncology (P.J.S., W.C.S., M.M.H., W.C.C., J.S.C., W.C.C., S.T.T.), Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
| | - Ming-Mo Hou
- Division of Hematology-Oncology (P.J.S., W.C.S., M.M.H., W.C.C., J.S.C., W.C.C., S.T.T.), Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
| | - Wen-Chi Chou
- College of Medicine (C.H.H., W.C.C., J.S.C., W.C.C.), Chang Gung University, Tao-Yuan, Taiwan; Division of Hematology-Oncology (P.J.S., W.C.S., M.M.H., W.C.C., J.S.C., W.C.C., S.T.T.), Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
| | - Jen-Shi Chen
- College of Medicine (C.H.H., W.C.C., J.S.C., W.C.C.), Chang Gung University, Tao-Yuan, Taiwan; Division of Hematology-Oncology (P.J.S., W.C.S., M.M.H., W.C.C., J.S.C., W.C.C., S.T.T.), Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
| | - Wen-Cheng Chang
- College of Medicine (C.H.H., W.C.C., J.S.C., W.C.C.), Chang Gung University, Tao-Yuan, Taiwan; Division of Hematology-Oncology (P.J.S., W.C.S., M.M.H., W.C.C., J.S.C., W.C.C., S.T.T.), Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
| | - Siew Tzuh Tang
- Division of Hematology-Oncology (P.J.S., W.C.S., M.M.H., W.C.C., J.S.C., W.C.C., S.T.T.), Chang Gung Memorial Hospital, Tao-Yuan, Taiwan; School of Nursing, Medical College (S.T.T.), Chang Gung University, Tao-Yuan, Taiwan; Department of Nursing (S.T.T.), Chang Gung Memorial Hospital at Kaohsiung, Taiwan; Department of Nursing (S.T.T.), Chang Gung University of Science and Technology, Tao-Yuan, Taiwan.
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Aoki Y, Nakayama K, Yonekura Y. A randomized controlled trial on the effects of decision aids for choosing discharge destinations of older stroke patients. PLoS One 2024; 19:e0272115. [PMID: 38271437 PMCID: PMC10810461 DOI: 10.1371/journal.pone.0272115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 12/22/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND In Japanese medical practice, older stroke survivors are overwhelmed with information regarding their discharge locations, creating more decision-making challenges. A randomized controlled trial evaluated the influence of decision aids (DAs) for matching older stroke patients and their families' values concerning decisional conflict and participation in discharge destination decisions. METHODS Participants were randomly allocated to intervention and control groups. The intervention spanned two months, from admission to discharge, at which times participants were surveyed. DAs were provided to the intervention group, and brochures to the control group. The primary endpoint was decisional conflict, assessed using the Decisional Conflict Scale (DCS). The secondary endpoint decision-making participation was assessed using the Control Preference Scale (CPS) decision-making roles and a 10-point Visual Analog Scale for participation rate. An independent t-test analyzed decisional conflict scores and participation rates to examine between-group differences. The chi-square independence test evaluated roles in decision-making scores. Post hoc subgroup analyses were performed. RESULTS Ninety-nine participants (intervention group n = 51; control group n = 48) were included in the full analysis set, with a dropout rate of 38.4%. No significant group differences were found in decision-making conflict [t (99) = 0.69, p = 0.49, d = 0.14] and roles in decision-making scores [χ2 (5) = 3.65, p = 0.46]. However, a significant group difference was found in the participation rate [t (99) = 2.24, p = 0.03, d = 0.45]. DA tended to reduce uncertainty and promote participation rates, especially in participants living alone and unable to decide their discharge destination. CONCLUSIONS The use of DA with older stroke patients did not significantly decrease decisional conflicts. In addition, the participation rate in decision-making increased, but their active role did not. Further studies should be conducted to understand the methods of offering DA, their ideal durations, and identify their beneficiaries.
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Affiliation(s)
- Yoriko Aoki
- Department of Gerontological Nursing, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Kazuhiro Nakayama
- Graduate School of Nursing Science, St. Luke’s International University, Tokyo, Japan
| | - Yuki Yonekura
- Graduate School of Nursing Science, St. Luke’s International University, Tokyo, Japan
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Jaffa MN, Kirsch HL, Creutzfeldt CJ, Guanci M, Hwang DY, LeTavec D, Mahanes D, Natarajan G, Steinberg A, Zahuranec DB, Muehlschlegel S. Common Data Elements for Disorders of Consciousness: Recommendations from the Working Group on Goals-of-Care and Family/Surrogate Decision-Maker Data. Neurocrit Care 2023; 39:600-610. [PMID: 37704937 DOI: 10.1007/s12028-023-01796-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 06/22/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND To facilitate comparative research, it is essential for the fields of neurocritical care and rehabilitation to establish common data elements (CDEs) for disorders of consciousness (DoC). Our objective was to identify CDEs related to goals-of-care decisions and family/surrogate decision-making for patients with DoC. METHODS To achieve this, we formed nine CDE working groups as part of the Neurocritical Care Society's Curing Coma Campaign. Our working group focused on goals-of-care decisions and family/surrogate decision-makers created five subgroups: (1) clinical variables of surrogates, (2) psychological distress of surrogates, (3) decision-making quality, (4) quality of communication, and (5) quality of end-of-life care. Each subgroup searched for existing relevant CDEs in the National Institutes of Health/CDE catalog and conducted an extensive literature search for additional relevant study instruments to be recommended. We classified each CDE according to the standard definitions of "core", "basic", "exploratory", or "supplemental", as well as their use for studying the acute or chronic phase of DoC, or both. RESULTS We identified 32 relevant preexisting National Institutes of Health CDEs across all subgroups. A total of 34 new instruments were added across all subgroups. Only one CDE was recommended as disease core, the "mode of death" of the patient from the clinical variables subgroup. CONCLUSIONS Our findings provide valuable CDEs specific to goals-of-care decisions and family/surrogate decision-making for patients with DoC that can be used to standardize studies to generate high-quality and reproducible research in this area.
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Affiliation(s)
- Matthew N Jaffa
- Department of Neurology, Ayer Neuroscience Institute, Hartford Hospital, Hartford, CT, USA
| | - Hannah L Kirsch
- Department of Neurology, Stanford University School of Medicine, 453 Quarry Road, MC 5235, Palo Alto, CA, USA.
| | - Claire J Creutzfeldt
- Department of Neurology, Division of Stroke and Palliative Care, University of Washington, Seattle, WA, USA
| | - Mary Guanci
- Department of Neuroscience Nursing, Massachusetts General Hospital, Boston, MA, USA
| | - David Y Hwang
- Division of Neurocritical Care, Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | | | - Dea Mahanes
- Departments of Neurology and Neurosurgery, UVA Health, Charlottesville, VA, USA
| | - Girija Natarajan
- Department of Pediatrics, Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI, USA
| | - Alexis Steinberg
- Department of Neurology, Critical Care Medicine, and Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Darin B Zahuranec
- Department of Neurology, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Susanne Muehlschlegel
- Departments of Neurology, Anesthesiology/Critical Care and Surgery, University of Massachusetts Chan Medical School, Worcester, MA, USA
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Guay-Bélanger S, Aubin E, Cimon M, Archambault P, Blanchette V, Giguere A, Gogovor A, Morin M, Ben Charif A, Ben Gaied N, Bickerstaff J, Chénard N, Emond J, Gilbert J, Violet I, Légaré F. Engagement of Older Adults Receiving Home Care Services and Their Caregivers in Health Decisions in Partnership With Clinical Teams: Protocol for a Multimethod Study to Prioritize and Culturally Adapt Decision Aids for Home Care. JMIR Res Protoc 2023; 12:e53150. [PMID: 37889512 PMCID: PMC10696497 DOI: 10.2196/53150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Older adults (people aged 65 years and older) face many difficult decisions. Patient decision aids (PtDAs) can help them and their families make informed value-congruent decisions. Some PtDAs have been developed for the home care context, but little is known about scaling them for use with older adults in a different culture. OBJECTIVE This study aims to (1) assess the scalability of existing PtDAs for older adults in the home care context; (2) prioritize those that best match the decisional needs of older adults in home care; and (3) culturally adapt the prioritized PtDAs so they can be scaled successfully to the Quebec health care system. METHODS This multimethod study includes 3 phases. All phases will be overseen by a steering committee of older adults, caregivers, health professionals, decision makers, community organization representatives, and researchers with the needed expertise. In phase 1, we will use the Innovation Scalability Self-administered Questionnaire, a validated scalability self-assessment tool, to assess the scalability of 33 PtDAs previously identified in a systematic review. Based on their scalability, their quality (based on the International Patient Decision Aids Standards), and the importance of the decision point, we will retain approximately a third of these. In phase 2, we will conduct a 2-round web-based Delphi to prioritize the PtDAs selected in phase 1. Using a snowball recruitment strategy, we aim to recruit 60 Delphi participants in the province of Quebec, including older adults, caregivers, health professionals, decision makers involved in home care services, and PtDA experts. In the first round, we will ask participants to rate the importance of several PtDA decision points according to various criteria such as prevalence and difficulty on a 5-point Likert scale (1=not important to 5=very important). Approximately 6 of the highest-rated PtDAs will be retained for presentation in the second round, and we will select up to 3 PtDAs judged as having the highest priority for cultural adaptation. In phase 3, using the Chenel framework and user-centered design methods, we will update and adapt the PtDAs to the Quebec health care system and integrate these PtDAs into an interprofessional shared decision-making training program for home care teams. The adapted PtDAs will respect the International Patient Decision Aids Standards criteria. RESULTS This study was funded in March 2022 by the Canadian Institutes of Health Research. Data collection for the web-based Delphi began in October 2023. Results are expected to be published in May 2024. CONCLUSIONS This project will provide relevant and culturally appropriate decision support tools for older adults making difficult decisions and their home care teams that will be ready for scaling across the province of Quebec. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/53150.
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Affiliation(s)
- Sabrina Guay-Bélanger
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | - Emmanuelle Aubin
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | - Marie Cimon
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | - Patrick Archambault
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Department of Anesthesiology and Intensive Care, Université Laval, Quebec, QC, Canada
| | - Virginie Blanchette
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Anik Giguere
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Amédé Gogovor
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Michèle Morin
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Department of Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | | | | | | | - Nancy Chénard
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Julie Emond
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Julie Gilbert
- Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | - Isabelle Violet
- Ministère de la santé et des services sociaux du Québec, Quebec, QC, Canada
| | - France Légaré
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
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Jaffa MN, Kirsch HL, Creutzfeldt CJ, Guanci M, Hwang DY, LeTavec D, Mahanes D, Steinberg A, Natarajan G, Zahuranec DB, Muehlschlegel S. Common Data Elements for Disorders of Consciousness: Recommendations from the Working Group on Goals-of-care and Family/Surrogate Decision-Maker Data. RESEARCH SQUARE 2023:rs.3.rs-3084539. [PMID: 37461521 PMCID: PMC10350109 DOI: 10.21203/rs.3.rs-3084539/v1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
INTRODUCTION In order to facilitate comparative research, it is essential for the fields of neurocritical care and rehabilitation to establish common data elements (CDE) for disorders of consciousness (DoC). Our objective was to identify CDEs related to goals-of-care decisions and family/surrogate decision-making for patients with DoC. METHODS To achieve this, we formed nine CDE working groups as part of the Neurocritical Care Society's Curing Coma Campaign. Our working group focused on goals-of-care decisions and family/surrogate decision-makers created five subgroups: (1) clinical variables of surrogates, (2) psychological distress of surrogates, (3) decision-making quality, (4) quality of communication, and (5) quality of end-of-life care. Each subgroup searched for existing relevant CDEs in the NIH/CDE catalog and conducted an extensive literature search for additional relevant study instruments to be recommended. We classified each CDE according to the standard definitions of "core," "basic," "exploratory," or "supplemental," as well as their utility for studying the acute or chronic phase of DoC, or both. RESULTS We identified 32 relevant pre-existing NIH CDEs across all subgroups. A total of 34 new instruments were added across all subgroups. Only one CDE was recommended as disease core, the "mode of death" of the patient from the clinical variables subgroup. CONCLUSIONS Our findings provide valuable CDEs specific to goals-of-care decisions and family/surrogate decision-making for patients with DoC that can be used to standardize studies to generate high-quality and reproducible research in this area.
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Affiliation(s)
| | | | | | | | - David Y Hwang
- The University of North Carolina at Chapel Hill School of Medicine
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Naye F, Légaré F, Paquette JS, Tousignant-Laflamme Y, LeBlanc A, Gaboury I, Poitras ME, Toupin-April K, Li LC, Hoens A, Poirier MD, Décary S. Decisional needs assessment for patient-centred pain care in Canada: the DECIDE-PAIN study protocol. BMJ Open 2023; 13:e066189. [PMID: 37156591 PMCID: PMC10173373 DOI: 10.1136/bmjopen-2022-066189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
INTRODUCTION The 2021 Action Plan for Pain from the Canadian Pain Task Force advocates for patient-centred pain care at all levels of healthcare across provinces. Shared decision-making is the crux of patient-centred care. Implementing the action plan will require innovative shared decision-making interventions, specifically following the disruption of chronic pain care during the COVID-19 pandemic. The first step in this endeavour is to assess current decisional needs (ie, decisions most important to them) of Canadians with chronic pain across their care pathways. METHODS AND ANALYSIS DesignGrounded in patient-oriented research approaches, we will perform an online population-based survey across the ten Canadian provinces. We will report methods and data following the CROSS reporting guidelines.SamplingThe Léger Marketing company will administer the online population-based survey to its representative panel of 500 000 Canadians to recruit 1646 adults (age ≥18 years old) with chronic pain according to the definition by the International Association for the Study of Pain (eg, pain ≥12 weeks). ContentBased on the Ottawa Decision Support Framework, the self-administered survey has been codesigned with patients and contain six core domains: (1) healthcare services, consultation and postpandemic needs, (2) difficult decisions experienced, (3) decisional conflict, (4) decisional regret, (5) decisional needs and (6) sociodemographic characteristics. We will use several strategies such as random sampling to improve survey quality. AnalysisWe will perform descriptive statistical analysis. We will identify factors associated with clinically significant decisional conflict and decision regret using multivariate analyses. ETHICS AND DISSEMINATION Ethics was approved by the Research Ethics Board at the Research Centre of the Centre Hospitalier Universitaire de Sherbrooke (project #2022-4645). We will codesign knowledge mobilisation products with research patient partners (eg, graphical summaries and videos). Results will be disseminated via peer-reviewed journals and national and international conferences to inform the development of innovative shared decision-making interventions for Canadians with chronic pain.
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Affiliation(s)
- Florian Naye
- Faculty of Medicine and Health Sciences, School of Rehabilitation, Research Centre of the CHUS, CIUSSS de l'Estrie-CHUS, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - France Légaré
- Faculty of Medicine, Department of Family and Emergency Medicine, Universite Laval, Quebec, Quebec, Canada
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec, Quebec, Canada
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Québec, Québec, Canada
| | - Jean-Sébastien Paquette
- Faculty of Medicine, Department of Family and Emergency Medicine, Universite Laval, Quebec, Quebec, Canada
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec, Quebec, Canada
| | - Yannick Tousignant-Laflamme
- Faculty of Medicine and Health Sciences, School of Rehabilitation, Research Centre of the CHUS, CIUSSS de l'Estrie-CHUS, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Annie LeBlanc
- Faculty of Medicine, Department of Family and Emergency Medicine, Universite Laval, Quebec, Quebec, Canada
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec, Quebec, Canada
| | - Isabelle Gaboury
- Faculty of Medicine and Health Sciences, Department of Family Medecine and Emergency Medicine, Research Centre of the CIUSSS de l'Estrie-CHUS, Universite de Sherbrooke Faculte de medecine et des sciences de la sante, Longueuil, Quebec, Canada
| | - Marie-Eve Poitras
- Faculty of Medicine and Health Sciences, Department of Family Medicine, Research Centre of the CIUSS du Saguenay-Lac-Saint-Jean, Université de Sherbrooke, Chicoutimi, Quebec, Canada
- Centre de santé et de services sociaux de Chicoutimi, Quebec, Quebec, Canada
| | - Karine Toupin-April
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Institut du Savoir Montfort, Ottawa, Ontario, Canada
| | - Linda C Li
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Alison Hoens
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marie-Dominique Poirier
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean du Québec, Chicoutimi, Quebec, Canada
| | - Simon Décary
- Faculty of Medicine and Health Sciences, School of Rehabilitation, Research Centre of the CHUS, CIUSSS de l'Estrie-CHUS, University of Sherbrooke, Sherbrooke, Quebec, Canada
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9
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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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10
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Lognon T, Gogovor A, Plourde KV, Holyoke P, Lai C, Aubin E, Kastner K, Canfield C, Beleno R, Stacey D, Rivest LP, Légaré F. Predictors of Decision Regret among Caregivers of Older Canadians Receiving Home Care: A Cross-Sectional Online Survey. MDM Policy Pract 2022; 7:23814683221116304. [PMID: 35983319 PMCID: PMC9380233 DOI: 10.1177/23814683221116304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 06/13/2022] [Indexed: 11/21/2022] Open
Abstract
Background. In Canada, caregivers of older adults receiving home
care face difficult decisions that may lead to decision regret. We assessed
difficult decisions and decision regret among caregivers of older adults
receiving home care services and factors associated with decision regret.
Methods. From March 13 to 30, 2020, at the outbreak of the
COVID-19 pandemic, we conducted an online survey with caregivers of older adults
receiving home care in the 10 Canadian provinces. We distributed a
self-administered questionnaire through Canada’s largest and most representative
private online panel. We identified types of difficult health-related decisions
faced in the past year and their frequency and evaluated decision regret using
the Decision Regret Scale (DRS), scored from 0 to 100. We performed descriptive
statistics as well as bivariable and multivariable linear regression to identify
factors predicting decision regret. Results. Among 932
participants, the mean age was 42.2 y (SD = 15.6 y), and 58.4% were male. The
most frequently reported difficult decisions were regarding housing and safety
(75.1%). The mean DRS score was 28.8/100 (SD = 8.6). Factors associated with
less decision regret included higher caregiver age, involvement of other family
members in the decision-making process, wanting to receive information about the
options, and considering organizations interested in the decision topic and
health care professionals as trustworthy sources of information (all
P < 0.001). Factors associated with more decision regret
included mismatch between the caregiver’s preferred option and the decision
made, the involvement of spouses in the decision-making process, higher
decisional conflict, and higher burden of care (all P <
0.001). Discussion. Decisions about housing and safety were the
difficult decisions most frequently encountered by caregivers of older adults in
this survey. Our results will inform future decision support interventions.
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Affiliation(s)
- Tania Lognon
- VITAM – Centre de recherche en santé durable, Quebec, QC, Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada
- Research Center CHU de Québec, Université Laval, Quebec, QC, Canada
| | - Amédé Gogovor
- VITAM – Centre de recherche en santé durable, Quebec, QC, Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada
- Research Center CHU de Québec, Université Laval, Quebec, QC, Canada
- Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Quebec, QC, Canada
| | - Karine V. Plourde
- VITAM – Centre de recherche en santé durable, Quebec, QC, Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada
- Research Center CHU de Québec, Université Laval, Quebec, QC, Canada
| | - Paul Holyoke
- SE Research Centre, SE Health, Markham, ON, Canada
| | - Claudia Lai
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada
| | | | | | - Carolyn Canfield
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada
- Caregiver Partner, Canada
| | | | - Dawn Stacey
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Patient Decision Aids Research Group, Clinical Epidemiology Program, Ottawa, ON, Canada
| | - Louis-Paul Rivest
- Tier 1 Canada Research Chair in Statistical Sampling and Data Analysis, Université Laval, Quebec, QC, Canada
- Faculty of Sciences and Engineering, Department of Mathematics and Statistics, Université Laval, Quebec, QC, Canada
| | - France Légaré
- VITAM – Centre de recherche en santé durable, Quebec, QC, Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada
- Research Center CHU de Québec, Université Laval, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC, Canada
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11
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Lai C, Holyoke P, Plourde KV, Yeung L, Légaré F. Home care providers' perceptions of shared decision-making with older clients (and their caregivers): A cross-sectional study. Nurs Health Sci 2022; 24:487-498. [PMID: 35460164 PMCID: PMC9322282 DOI: 10.1111/nhs.12946] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/06/2022] [Accepted: 04/09/2022] [Indexed: 11/28/2022]
Abstract
Interprofessional care teams can play a key role in supporting older adults (and caregivers) in making informed health decisions, yet shared decision making is not widely practiced in home care. Based on an earlier needs assessment with older adults (and caregivers) with home care experience, we aimed to explore the perceptions of home care teams on the decisions facing their clients and their perceived involvement in shared decision making. A cross-sectional study was conducted with 614 home care providers (nurses, personal support workers, rehabilitation professionals) in three Canadian provinces (Quebec, Ontario, and Alberta). Home care providers considered the decision "to stay at home or move" as the most difficult for older adults. Those most frequently involved in decision making with older adults were family members and least involved were physicians. Although all home care providers reported high levels of shared decision-making, we detected an effect of respondent's discipline on self-perceived shared decision-making; nurses and rehabilitation professionals reported significantly higher levels of shared decision making than personal support workers. A more tailored approach is required to support shared decision making in interprofessional care teams.
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Affiliation(s)
- Claudia Lai
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, Quebec, Canada.,SE Research Centre, SE Health, Markham, Ontario, Canada.,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,School of Health Information Science, University of Victoria, Victoria, British Columbia, Canada
| | - Paul Holyoke
- SE Research Centre, SE Health, Markham, Ontario, Canada
| | - Karine V Plourde
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, Quebec, Canada.,VITAM Centre de recherche en santé durable, Quebec, Quebec, Canada.,CHU de Québec Research Centre, Université Laval, Quebec, Quebec, Canada
| | - Lily Yeung
- Participant Partner, Toronto, Ontario, Canada
| | - France Légaré
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, Quebec, Canada.,VITAM Centre de recherche en santé durable, Quebec, Quebec, Canada.,CHU de Québec Research Centre, Université Laval, Quebec, Quebec, Canada.,Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Quebec, Canada
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12
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Elidor H, Adekpedjou R, Zomahoun HTV, Ben Charif A, Agbadjé TT, Rheault N, Légaré F. Extent and Predictors of Decision Regret among Informal Caregivers Making Decisions for a Loved One: A Systematic Review. Med Decis Making 2020; 40:946-958. [PMID: 33089748 PMCID: PMC7672779 DOI: 10.1177/0272989x20963038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 08/30/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Informal caregivers often serve as decision makers for dependent or vulnerable individuals facing health care decisions. Decision regret is one of the most prevalent outcomes reported by informal caregivers who have made such decisions. OBJECTIVE To examine levels of decision regret and its predictors among informal caregivers who have made health-related decisions for a loved one. DATA SOURCES We performed a systematic search of Embase, MEDLINE, Web of Science, and Google Scholar up to November 2018. Participants were informal caregivers, and the outcome was decision regret as measured using the Decision Regret Scale (DRS). REVIEW METHODS Two reviewers independently selected eligible studies, extracted data, and assessed the methodological quality of studies using the Mixed Methods Appraisal Tool. We performed a narrative synthesis and presented predictors of decision regret using a conceptual framework, dividing the predictors into decision antecedents, decision-making process, and decision outcomes. RESULTS We included 16 of 3003 studies identified. Most studies (n = 13) reported a mean DRS score ranging from 7.0 to 32.3 out of 100 (median = 14.3). The methodological quality of studies was acceptable. We organized predictors and their estimated effects (β) or odds ratio (OR) with 95% confidence interval (CI) as follows: decision antecedents (e.g., caregivers' desire to avoid the decision, OR 2.07, 95% CI [1.04-4.12], P = 0.04), decision-making process (e.g., caregivers' perception of effective decision making, β = 0.49 [0.05, 0.93], P < 0.01), and decision outcomes (e.g., incontinence, OR = 4.4 [1.1, 18.1], P < 0.001). CONCLUSIONS This review shows that informal caregivers' level of decision regret is generally low but is high for some decisions. We also identified predictors of regret during different stages of the decision-making process. These findings may guide future research on improving caregivers' experiences.
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Affiliation(s)
- Hélène Elidor
- />VITAM–Centre de recherche en santé durable, Quebec, QC, Canada
- />Canada Research Chair in Shared Decision Making and Knowledge Translation (Tier 1) and Population Health and Practice-Changing Research Group, Quebec, QC, Canada
- />Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Rhéda Adekpedjou
- Canada Research Chair in Shared Decision Making and Knowledge Translation (Tier 1) and Population Health and Practice-Changing Research Group, Quebec, QC, Canada
| | - Hervé Tchala Vignon Zomahoun
- />VITAM–Centre de recherche en santé durable, Quebec, QC, Canada
- />Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec, QC, Canada
- />Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Ali Ben Charif
- />VITAM–Centre de recherche en santé durable, Quebec, QC, Canada
- />Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec, QC, Canada
- />Canada Research Chair in Shared Decision Making and Knowledge Translation (Tier 1) and Population Health and Practice-Changing Research Group, Quebec, QC, Canada
- />Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC, Canada
| | - Titilayo Tatiana Agbadjé
- />VITAM–Centre de recherche en santé durable, Quebec, QC, Canada
- />Canada Research Chair in Shared Decision Making and Knowledge Translation (Tier 1) and Population Health and Practice-Changing Research Group, Quebec, QC, Canada
| | - Nathalie Rheault
- />VITAM–Centre de recherche en santé durable, Quebec, QC, Canada
- />Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec, QC, Canada
| | - France Légaré
- />VITAM–Centre de recherche en santé durable, Quebec, QC, Canada
- />Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec, QC, Canada
- />Canada Research Chair in Shared Decision Making and Knowledge Translation (Tier 1) and Population Health and Practice-Changing Research Group, Quebec, QC, Canada
- />Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC, Canada
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