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Adekpedjou R, Léon P, Dewidar O, Al‐Zubaidi A, Jbilou J, Kaczorowski J, Muscedere J, Hirdes J, Heckman G, Girard M, Hébert PC. Effectiveness of interventions to address different types of vulnerabilities in community-dwelling older adults: An umbrella review. Campbell Syst Rev 2023; 19:e1323. [PMID: 37180567 PMCID: PMC10168691 DOI: 10.1002/cl2.1323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Background Frailty, social isolation, loneliness, and poverty may render older adults vulnerable to social or health stressors. It is imperative to identify effective interventions to address them especially in the context of COVID-19 pandemic. Objective To identify effective community-based interventions to address frailty, social isolation, loneliness, and poverty among community-dwelling older adults. Design Umbrella review. Data Source We systematically searched PubMed, Ovid MEDLINE, Embase, Cochrane CENTRAL, EBM-Reviews, CINAHL via EBSCO, and APA PsycInfo via Ovid from January 2009 to December 2022. Eligibility Criteria We included systematic reviews or quantitative reviews of non-pharmacologic interventions targeting community-dwelling older adults. Data Selection Extraction and Management Two review authors independently screened the titles and abstracts, performed data extraction and appraised the methodological quality of the reviews. We used a narrative synthesis approach to summarize and interpret the findings. We assessed the methodological quality of the studies using AMSTAR 2.0 tool. Results We identified 27 reviews incorporating 372 unique primary studies that met our inclusion criteria. Ten of the reviews included studies conducted in low-middle-income countries. Twelve reviews (46%, 12/26) included interventions that addressed frailty. Seventeen reviews (65%, 17/26) included interventions that addressed either social isolation or loneliness. Eighteen reviews included studies with single component interventions, while 23 reviews included studies with multi-component interventions. Interventions including protein supplementation combined with physical activity may improve outcomes including frailty status, grip strength, and body weight. Physical activity alone or in combination with diet may prevent frailty. Additionally, physical activity may improve social functioning and interventions using digital technologies may decrease social isolation and loneliness. We did not find any review of interventions addressing poverty among older adults. We also noted that few reviews addressed multiple vulnerabilities within the same study, specifically addressed vulnerability among ethnic and sexual minority groups, or examined interventions that engaged communities and adapted programs to local needs. Conclusion Evidence from reviews support diets, physical activity, and digital technologies to improve frailty, social isolation or loneliness. However, interventions examined were primarily conducted under optimal conditions. There is a need for further interventions in community settings and conducted under real world settings in older adults living with multiple vulnerabilities.
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Affiliation(s)
- Rhéda Adekpedjou
- Carrefour de l'innovation et de l'évaluation en santéCentre Hospitalier de l'Université de MontréalMontréalCanada
| | - Pascale Léon
- Carrefour de l'innovation et de l'évaluation en santéCentre Hospitalier de l'Université de MontréalMontréalCanada
| | - Omar Dewidar
- Bruyère Research InstituteUniversity of OttawaOttawaOntarioCanada
| | - Ali Al‐Zubaidi
- Bruyère Research InstituteUniversity of OttawaOttawaOntarioCanada
| | - Jalila Jbilou
- Centre de formation médicale du Nouveau‐Brunswick et École de psychologie, Faculté des sciences de la santé et des services communautairesUniversité de MonctonNouveau‐BrunswickCanada
| | - Janusz Kaczorowski
- Carrefour de l'innovation et de l'évaluation en santéCentre Hospitalier de l'Université de MontréalMontréalCanada
| | - John Muscedere
- Department of Critical Care MedicineQueens University and Canadian Frailty NetworkKingstonOntarioCanada
| | - John Hirdes
- Centre de formation médicale du Nouveau‐Brunswick et École de psychologie, Faculté des sciences de la santé et des services communautairesUniversité de MonctonNouveau‐BrunswickCanada
| | - George Heckman
- School of Public Health and Health SystemsUniversity of WaterlooWaterlooCanada
- Schlegel Research Institute for AgingWaterlooCanada
| | - Magali Girard
- Bureau de Recherche Développement ValorisationUniversité de MontréalMontréalCanada
| | - Paul C. Hébert
- Carrefour de l'innovation et de l'évaluation en santéCentre Hospitalier de l'Université de MontréalMontréalCanada
- Bruyère Research InstituteUniversity of OttawaOttawaOntarioCanada
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Betini GS, Hirdes JP, Adekpedjou R, Perlman CM, Huculak N, Hébert P. Longitudinal Trends and Risk Factors for Depressed Mood Among Canadian Adults During the First Wave of COVID-19. Front Psychiatry 2021; 12:666261. [PMID: 34335324 PMCID: PMC8322735 DOI: 10.3389/fpsyt.2021.666261] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 06/21/2021] [Indexed: 12/17/2022] Open
Abstract
Background: The COVID-19 pandemic has raised serious concerns about the mental health impact of people directed and indirectly affected by the virus. Because this is a rapidly evolving situation, our goal was to explore potential risk factors and trends in feelings of anxiety and depression among the general population in Canada over the first 5 months of the pandemic. Methods: We completed on-line surveys of 3,127 unique individuals representative of the Canadian general population at 4 discreet periods every 6 weeks from April 15th to July 28th 2020. We assessed feelings of anxiety, depression and loss of interest with the interRAI self-reported mood scale using a multivariable generalized estimating equation model to examine factors associated with having a 5+ score on the scale (indicating potentially depressed mood). We also investigated potential longitudinal trends to examine temporal variation in mood scores. Results: More than 30% of participants felt highly anxious, depressed, and disinterested in everyday activities in the first survey (April), but this number decreased to about 20% over 4 months. Feeling lonely, younger age, feeling overwhelmed by one's health needs, having financial concerns, and living outside of Québec were significantly associated with depressed mood. Interpretation: The prevalence of depressed mood during the pandemic was between 2 and 3 times the pre-pandemic rate (especially among young people), but it can change rapidly in response to social changes. Thus, monitoring of psychological distress among vulnerable groups that may benefit from additional supports should be a priority.
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Affiliation(s)
- Gustavo S Betini
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - John P Hirdes
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Rhéda Adekpedjou
- Centre de Recherche CHUM (Centre Hospitalier de l'Université de Montréal), Montréal, QC, Canada
| | - Christopher M Perlman
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | | | - Paul Hébert
- Department of Medicine, Université de Montréal, Centre de Recherche CHUM (Centre Hospitalier de l'Université de Montréal), Montréal, QC, Canada
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Agbadjé TT, Elidor H, Perin MS, Adekpedjou R, Légaré F. Towards a taxonomy of behavior change techniques for promoting shared decision making. Implement Sci 2020; 15:67. [PMID: 32819410 PMCID: PMC7439658 DOI: 10.1186/s13012-020-01015-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 07/01/2020] [Indexed: 12/02/2022] Open
Abstract
Background There is little information about the functions and behavior change techniques (BCTs) needed to implement shared decision making (SDM) in clinical practice. To guide future implementation initiatives, we sought to develop a BCT taxonomy for SDM implementation interventions. Methods This study is a secondary analysis of a 2018 Cochrane review on interventions for increasing the use of shared decision making by healthcare professionals. We examined all 87 studies included in the review. We extracted relevant information on each study intervention into a spreadsheet. Coders had undergone a training workshop on intervention functions and online training on BCT Taxonomy version 1 (BCTTv1). We performed functions and BCTs coding trials, and identified coding rules. We used Michie’s guide for designing behavior change interventions to code the functions and BCTs used in the interventions. Coders met to compare coding and discrepancies were discussed until consensus was reached. Data was analyzed using simple descriptive statistics. Results Overall, 7 functions, 24 combinations of functions and 32 BCTs were used in the 87 SDM implementation interventions. The mean of functions per intervention was 2.5 and the mean of BCTs per intervention was 3.7. The functions Coercion and Restriction were not found. The most common function was Education (73 studies). Three combinations of functions were most common (e.g: Education + Persuasion, used in 10 studies). The functions associated with more effective SDM implementation interventions were Modeling and Training. The most effective combination of functions was Education + Training + Modeling + Enablement. The most commonly used BCT was Instruction on how to perform the behavior (43 studies). BCTs associated with more effective SDM implementation interventions were: Instruction on how to perform the behavior, Demonstration of the behavior, Feedback on behavior, Pharmacological support, Material reward, and Biofeedback. Twenty-five BCTs were associated with less effective SDM implementation interventions. Four new BCTs were identified: General information to support the behavior, Tailoring, Exercises to conceptually prepare for the behavior, and Experience sharing and learning. Conclusions We established a BCT taxonomy specific to the field of SDM to guide future SDM implementation interventions. Four new BCTs should be added to BCTTv1.
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Affiliation(s)
- Titilayo Tatiana Agbadjé
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, Canada.,Centre de recherche en santé durable (VITAM), Quebec, QC, Canada.,Centre Intégré Universitaire de Santé et Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec, QC, Canada
| | - Hélène Elidor
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, Canada.,Centre de recherche en santé durable (VITAM), Quebec, QC, Canada.,Centre Intégré Universitaire de Santé et Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec, QC, Canada
| | | | - Rhéda Adekpedjou
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, Canada.,Centre de recherche en santé durable (VITAM), Quebec, QC, Canada.,Centre Intégré Universitaire de Santé et Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec, QC, Canada
| | - France Légaré
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, Canada. .,Centre de recherche en santé durable (VITAM), Quebec, QC, Canada. .,Centre Intégré Universitaire de Santé et Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec, QC, Canada. .,Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Canada.
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Adekpedjou R, Stacey D, Brière N, Freitas A, Garvelink MM, Dogba MJ, Durand PJ, Desroches S, Croteau J, Rivest LP, Légaré F. Engaging Caregivers in Health-Related Housing Decisions for Older Adults With Cognitive Impairment: A Cluster Randomized Trial. Gerontologist 2020; 60:947-957. [PMID: 31095318 PMCID: PMC7362613 DOI: 10.1093/geront/gnz045] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Indexed: 12/22/2022] Open
Abstract
Background and Objectives Informal caregivers are rarely as involved as they want to be in the housing decisions of cognitively impaired older adults. Lack of awareness of available options and their benefits and risks may lead to decisions that do not reflect older adults’ preferences, and to guilt and regret. We assessed the effect of training home care teams in interprofessional shared decision-making (SDM) on the proportion of caregivers who report being active in this decision. Research Design and Methods In a two-arm pragmatic cluster randomized trial with home care teams working in health centers in the Province of Quebec, we randomized health centers to receive training in interprofessional SDM (intervention) or not (control). Eligible caregivers had made a housing decision for a cognitively impaired adult aged 65 years or older who was receiving services from a home care team. The primary outcome was the proportion of caregivers reporting an active role in decision making. We performed intention-to-treat multilevel analysis. Results We consecutively enrolled a random group of 16 health centers and recruited 309 caregivers, among whom 296 were included in the analysis. In the intervention arm, the proportion of caregivers reporting an active role in decision making increased by 12% (95% CI −2% to 27%; p = .10). After removal of an influential cluster outlier, the proportion increased to 18% (95% CI: 7%–29%; p < .01). Discussion and Implications Training home care teams in interprofessional SDM increased caregiver involvement in health-related housing decisions for cognitively impaired older adults.
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Affiliation(s)
- Rhéda Adekpedjou
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Québec, Canada
| | - Dawn Stacey
- Ottawa Hospital Research Institute and Faculty of Health Sciences, University of Ottawa, Ontario, Canada
| | - Nathalie Brière
- Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Canada
| | - Adriana Freitas
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Québec, Canada
| | - Mirjam M Garvelink
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Québec, Canada
| | | | | | - Sophie Desroches
- School of Nutrition, Québec, Canada.,CHU de Québec Research Centre, Québec, Canada
| | - Jordie Croteau
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Québec, Canada
| | - Louis-Paul Rivest
- Department of Mathematics and Statistics, Université Laval, Québec, Canada
| | - France Légaré
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Québec, Canada
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Elidor H, Ben Charif A, Djade CD, Adekpedjou R, Légaré F. Decision Regret among Informal Caregivers Making Housing Decisions for Older Adults with Cognitive Impairment: A Cross-sectional Analysis. Med Decis Making 2020; 40:416-427. [PMID: 32522090 DOI: 10.1177/0272989x20925368] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Informal caregivers are regularly faced with difficult housing decisions for older adults with cognitive impairment. They often regret the decision they made. We aimed to identify factors associated with decision regret among informal caregivers engaging in housing decisions for cognitively impaired older adults. Methods. We performed a secondary analysis of cross-sectional data collected from a cluster-randomized trial. Eligible participants were informal caregivers involved in making housing decisions for cognitively impaired older adults. Decision regret was assessed after caregivers' enrollment in the study using the Decision Regret Scale (DRS), scored from 0 to 100. We used a conceptual framework of potential predictors of regret to identify independent variables. We performed multilevel analyses using a mixed linear model by estimating fixed effects (β) and 95% confidence intervals (CIs). Results. The mean (SD) DRS score of 296 informal caregivers (mean [SD] age, 62 [12] years) was 12.4 (18.4). Factors associated with less decision regret were having a college degree compared to primary education (β [95% CI]: -11.14 [-18.36, -3.92]), being married compared to being single (-5.60 [-10.05, -1.15]), informal caregivers' perception that a joint process occurred (-0.14 [-0.25, -0.02]), and older adults' not having a specific housing preference compared to preferring to stay at home (-4.13 [-7.40, -0.86]). Factors associated with more decision regret were being retired compared to being a homemaker (7.74 [1.32, 14.16]), higher burden of care (0.14 [0.05, 0.22]), and higher decisional conflict (0.51 [0.34, 0.67]). Limitations. Our analysis may not illustrate all predictors of decision regret among informal caregivers. Conclusions. Our findings will allow risk-mitigation strategies for informal caregivers at risk of experiencing regret.
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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, VITAM - Centre de recherche en santé durable, 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, VITAM - Centre de recherche en santé durable, Quebec, QC, Canada
| | - Codjo Djignefa Djade
- 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, VITAM - Centre de recherche en santé durable, Quebec, QC, Canada
| | - Rhéda Adekpedjou
- 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, VITAM - Centre de recherche en santé durable, 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, VITAM - Centre de recherche en santé durable, Quebec, QC, Canada.,Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC, Canada
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7
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Hessou SPH, Glele-Ahanhanzo Y, Adekpedjou R, Ahoussinou C, Djade CD, Biaou A, Johnson CR, Boko M, Alary M. HIV incidence and risk contributing factors among men who have sex with men in Benin: A prospective cohort study. PLoS One 2020; 15:e0233624. [PMID: 32516307 PMCID: PMC7282649 DOI: 10.1371/journal.pone.0233624] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 05/08/2020] [Indexed: 12/18/2022] Open
Abstract
Men who have sex with Men (MSM) are a key population in the transmission of Human Immunodeficiency Virus (HIV) infection. In Benin, there is a lack of strategic information to offer appropriate interventions for these populations who live hidden due to their stigmatization and discrimination. The objective is to identify contributing factors that affect HIV incidence in the MSM population. Study of a prospective cohort of 358 HIV-negative MSM, aged 18 years and over, reporting having had at least one oral or anal relationship with another man during the last 12 months, prior to recruitment. The monitoring lasted 30 months with a follow-up visit every six months. Univariate analyses and a Cox proportional hazards multivariate regression were used to examine the association between bio-behavioral, socio-demographic and knowledge-related characteristics with HIV incidence. The retention rate for the follow-up of the 358 participants was 94.5%. On the 813.5 person-years of follow-up, 48 seroconversions with an HIV incidence of 5.91 per 100 person-years were observed (95% CI: 4.46–7.85). Factors associated with the high risk of HIV were age (HR = 0.4; 95% CI: 0.2–0.8), living in couple (HR = 0.5 95% CI: 0.2–0.96) and the lack of condom systematic use with a male partner during high-risk sex (HR = 3.9; 95% CI: 1.4–11.1). HIV incidence is high within MSM population and particularly among young people. Targeted, suitable and cost-effective interventions for the delivery of the combination prevention package in an environment free of stigma and discrimination are necessary and vital for reaching the 90x90x90 target.
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Affiliation(s)
- Septime P. H. Hessou
- National Reference Centre for AIDS Research and Care (CNRRPEC-CNHU/Bénin), Cotonou, Bénin
- Population Health and Best Practices in Health Axis Quebec City University Hospital Research Center Laval University, Hôpital du Saint-Sacrement, Québec, Canada
- Inter-faculty Centre for Training and Research in Environment for Development (CIFRED), Abomey-Calavi University (UAC), Calavi, Bénin
- * E-mail:
| | - Yolaine Glele-Ahanhanzo
- Regional Institute of Public Health (IRSP), University of Abomey-Calavi (UAC), Ouidah, Bénin
| | - Rhéda Adekpedjou
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Université de Montréal, Quebec, Canada
| | - Clement Ahoussinou
- Institute for the Analysis of Communication and Social Groups, Missereté, Bénin
| | - Codjo D. Djade
- Population Health and Best Practices in Health Axis Quebec City University Hospital Research Center Laval University, Hôpital du Saint-Sacrement, Québec, Canada
| | | | - Christian R. Johnson
- Inter-faculty Centre for Training and Research in Environment for Development (CIFRED), Abomey-Calavi University (UAC), Calavi, Bénin
| | - Michel Boko
- Inter-faculty Centre for Training and Research in Environment for Development (CIFRED), Abomey-Calavi University (UAC), Calavi, Bénin
| | - Michel Alary
- Population Health and Best Practices in Health Axis Quebec City University Hospital Research Center Laval University, Hôpital du Saint-Sacrement, Québec, Canada
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Adekpedjou R, Haesebaert J, Stacey D, Brière N, Freitas A, Rivest LP, Légaré F. Variations in factors associated with healthcare providers' intention to engage in interprofessional shared decision making in home care: results of two cross-sectional surveys. BMC Health Serv Res 2020; 20:203. [PMID: 32164669 PMCID: PMC7069220 DOI: 10.1186/s12913-020-5064-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 02/28/2020] [Indexed: 12/14/2022] Open
Abstract
Background DOLCE (Improving Decision making On Location of Care with the frail Elderly and their caregivers) was a post-intervention clustered randomised trial (cRT) to assess the effect of training home care teams on interprofessional shared decision-making (IP-SDM). Alongside the cRT, we sought to monitor healthcare providers’ level of behavioural intention to engage in an IP-SDM approach and to identify factors associated with this intention. Methods We conducted two cross-sectional surveys in the province of Quebec, Canada, one each at cRT entry and exit. Healthcare providers (e.g. nurses, occupational therapists and social workers) in the 16 participating intervention and control sites self-completed an identical paper-based questionnaire at entry and exit. Informed by the Integrated model for explaining healthcare professionals’ clinical behaviour by Godin et al. (2008), we assessed their behavioural intention to engage in IP-SDM to support older adults and caregivers of older adults with cognitive impairment to make health-related housing decisions. We also assessed psychosocial variables underlying their behavioural intention and collected sociodemographic data. We used descriptive statistics and linear mixed models to account for clustering. Results Between 2014 and 2016, 271 healthcare providers participated at study entry and 171 at exit. At entry, median intention level was 6 in a range of 1 (low) to 7 (high) (Interquartile range (IQR): 5–6.5) and factors associated with intention were social influence (β = 0.27, P < 0.0001), beliefs about one’s capabilities (β = 0.43, P < 0.0001), moral norm (β = 0.31, P < 0.0001) and beliefs about consequences (β = 0.21, P < 0.0001). At exit, median intention level was 5.5 (IQR: 4.5–6.5). Factors associated with intention were the same but did not include moral norm. However, at exit new factors were kept in the model: working in rehabilitation (β = − 0.39, P = 0.018) and working as a technician (β = − 0.41, P = 0.069) (compared to as a social worker). Conclusion Intention levels were high but decreased from entry to exit. Factors associated with intention also changed from study entry to study exit. These findings may be explained by the major restructuring of the health and social care system that took place during the 2 years of the study, leading to rapid staff turnover and organisational disturbance in home care teams. Future research should give more attention to contextual factors and design implementation interventions to withstand the disruption of system- and organisational-level disturbances. Trial registration Clinicaltrials.gov (NCT02244359). Registered on September 19th, 2014.
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Affiliation(s)
- Rhéda Adekpedjou
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Quebec, Canada
| | - Julie Haesebaert
- Université de Lyon, Université Claude Bernard Lyon 1, Université Saint-Étienne, HESPER EA 7425, F-69008 Lyon, F-42023, Saint-Etienne, France
| | - Dawn Stacey
- Ottawa Hospital Research Institute and Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Nathalie Brière
- Centre intégré universitaire en santé et services sociaux de la Capitale-Nationale, Quebec, Canada
| | - Adriana Freitas
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Quebec, Canada
| | - Louis-Paul Rivest
- Department of Mathematics and Statistics, Université Laval, Quebec, Canada
| | - France Légaré
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Quebec, Canada. .,Canada Research Chair in Shared Decision Making and Knowledge Translation, 2525, chemin de la Canardière, Quebec, G1J 0A4, Canada.
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Boucher A, Haesebaert J, Freitas A, Adekpedjou R, Landry M, Bourassa H, Stacey D, Croteau J, Painchaud Guérard G, Légaré F. Correction to: Time to move? Factors associated with burden of care among informal caregivers of cognitively impaired older people facing housing decisions: secondary analysis of a cluster randomized trial. BMC Geriatr 2020; 20:42. [PMID: 32020852 PMCID: PMC7001301 DOI: 10.1186/s12877-020-1437-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Following publication of the original article [1], we have been notified that one of the authors' given name and last names are reversed and misspelled and thus not reflected correctly (given name now is Painchaud-Guérard and it should be Geneviève and last name now is Geneviève and it should be Painchaud Guérard).
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Affiliation(s)
- Alexandrine Boucher
- Canada Research Chair in Shared Decision Making and Knowledge Translation, and Population Health and Practice-Changing Research Group, Université Laval Primary Care Research Centre (CERSSPL-UL), Quebec, Canada.,Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Canada
| | - Julie Haesebaert
- Canada Research Chair in Shared Decision Making and Knowledge Translation, and Population Health and Practice-Changing Research Group, Université Laval Primary Care Research Centre (CERSSPL-UL), Quebec, Canada.,Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Canada
| | - Adriana Freitas
- Canada Research Chair in Shared Decision Making and Knowledge Translation, and Population Health and Practice-Changing Research Group, Université Laval Primary Care Research Centre (CERSSPL-UL), Quebec, Canada
| | - Rhéda Adekpedjou
- Canada Research Chair in Shared Decision Making and Knowledge Translation, and Population Health and Practice-Changing Research Group, Université Laval Primary Care Research Centre (CERSSPL-UL), Quebec, Canada.,Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Canada
| | - Marjolaine Landry
- Department of Nursing of Université du Québec à Trois-Rivières, Quebec, Canada
| | | | - Dawn Stacey
- Ottawa Hospital Research Institute, Ottawa, Canada.,School of Nursing, University of Ottawa, Ottawa, Canada
| | - Jordie Croteau
- Canada Research Chair in Shared Decision Making and Knowledge Translation, and Population Health and Practice-Changing Research Group, Université Laval Primary Care Research Centre (CERSSPL-UL), Quebec, Canada.,Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Canada
| | - Geneviève Painchaud Guérard
- Canada Research Chair in Shared Decision Making and Knowledge Translation, and Population Health and Practice-Changing Research Group, Université Laval Primary Care Research Centre (CERSSPL-UL), Quebec, Canada.,Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Canada
| | - France Légaré
- Canada Research Chair in Shared Decision Making and Knowledge Translation, and Population Health and Practice-Changing Research Group, Université Laval Primary Care Research Centre (CERSSPL-UL), Quebec, Canada. .,Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Canada. .,Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale, Pavillon Landry-Poulin, entrée A-1-2, bureau A-4574, 2525, chemin de la Canardière, Quebec, QC, G1J 0A4, Canada.
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Zomahoun HTV, Ben Charif A, Freitas A, Garvelink MM, Menear M, Dugas M, Adekpedjou R, Légaré F. The pitfalls of scaling up evidence-based interventions in health. Glob Health Action 2020; 12:1670449. [PMID: 31575331 PMCID: PMC6781190 DOI: 10.1080/16549716.2019.1670449] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Policy-makers worldwide are increasingly interested in scaling up evidence-based interventions (EBIs) to larger populations, and implementation scientists are developing frameworks and methodologies for achieving this. But scaling-up does not always produce the desired results. Why not? We aimed to enhance awareness of the various pitfalls to be anticipated when planning scale-up. In lower- and middle-income countries (LMICs), the scale-up of health programs to prevent or respond to outbreaks of communicable diseases has been occurring for many decades. In high-income countries, there is new interest in the scaling up of interventions that address communicable and non-communicable diseases alike. We scanned the literature worldwide on problems encountered when implementing scale-up plans revealed a number of potential pitfalls that we discuss in this paper. We identified and discussed the following six major pitfalls of scaling-up EBIs: 1) the cost-effectiveness estimation pitfall, i.e. accurate cost-effectiveness estimates about real-world implementation are almost impossible, making predictions of economies of scale unreliable; 2) the health inequities pitfall, i.e. some people will necessarily be left out and therefore not benefit from the scaled-up EBIs; 3) the scaled-up harm pitfall, i.e. the harms as well as the benefits may be amplified by the scaling-up; 4) the ethical pitfall, i.e. informed consent may be a challenge on a grander scale; 5) the top-down pitfall, i.e. the needs, preferences and culture of end-users may be forgotten when scale-up is directed from above; and 6) the contextual pitfall, i.e. it may not be possible to adapt the EBIs to every context. If its pitfalls are addressed head on, scaling-up may be a powerful process for translating research data into practical improvements in healthcare in both LMICs and high-income countries, ensuring that more people benefit from EBIs.
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Affiliation(s)
- Hervé Tchala Vignon Zomahoun
- Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval , Quebec , QC , Canada.,Centre de recherche sur les soins et les services de première ligne - Université Laval (CERSSPL-UL), Université Laval , Quebec , QC , Canada
| | - Ali Ben Charif
- Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval , Quebec , QC , Canada.,Centre de recherche sur les soins et les services de première ligne - Université Laval (CERSSPL-UL), Université Laval , Quebec , QC , Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval , Quebec , QC , Canada.,Department of Family Medicine and Emergency Medicine, Université Laval , Quebec , QC , Canada
| | - Adriana Freitas
- Centre de recherche sur les soins et les services de première ligne - Université Laval (CERSSPL-UL), Université Laval , Quebec , QC , Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval , Quebec , QC , Canada
| | - Mirjam Marjolein Garvelink
- Centre de recherche sur les soins et les services de première ligne - Université Laval (CERSSPL-UL), Université Laval , Quebec , QC , Canada
| | - Matthew Menear
- Centre de recherche sur les soins et les services de première ligne - Université Laval (CERSSPL-UL), Université Laval , Quebec , QC , Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval , Quebec , QC , Canada.,Department of Family Medicine and Emergency Medicine, Université Laval , Quebec , QC , Canada
| | - Michèle Dugas
- Centre de recherche sur les soins et les services de première ligne - Université Laval (CERSSPL-UL), Université Laval , Quebec , QC , Canada
| | - Rhéda Adekpedjou
- Centre de recherche sur les soins et les services de première ligne - Université Laval (CERSSPL-UL), Université Laval , Quebec , QC , Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval , Quebec , QC , Canada
| | - France Légaré
- Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval , Quebec , QC , Canada.,Centre de recherche sur les soins et les services de première ligne - Université Laval (CERSSPL-UL), Université Laval , Quebec , QC , Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval , Quebec , QC , Canada.,Department of Family Medicine and Emergency Medicine, Université Laval , Quebec , QC , Canada.,Population Health and Practice-Changing Research Group, CHU de Québec Research Centre , Quebec , QC , Canada
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Boucher A, Haesebaert J, Freitas A, Adekpedjou R, Landry M, Bourassa H, Stacey D, Croteau J, Geneviève PG, Légaré F. Time to move? Factors associated with burden of care among informal caregivers of cognitively impaired older people facing housing decisions: secondary analysis of a cluster randomized trial. BMC Geriatr 2019; 19:249. [PMID: 31500590 PMCID: PMC6734334 DOI: 10.1186/s12877-019-1249-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 08/15/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Making health-related decisions about loved ones with cognitive impairment may contribute to caregiver burden of care. We sought to explore factors associated with burden of care among informal caregivers who had made housing decisions on behalf of a cognitively impaired older person. METHODS We conducted a secondary analysis within a cluster randomized trial (cRT) conducted in 16 publicly-funded home care service points across the Province of Quebec. The cRT assessed the impact of training home care teams in interprofessional shared decision making (IP-SDM). We assessed burden of care with the Zarit Burden Interview (ZBI) scale. We adapted Pallett's framework to inform our data analysis. This framework posits that factors influencing burden of care among caregivers fall within four domains: (a) characteristics of the caregiver, (b) characteristics of the cognitively impaired older person, (c) characteristics of the relationship between the caregiver and the cognitively impaired older person, and (d) the caregiver's perception of their social support resources. We computed the ZBI score and performed multilevel linear regression modelling. RESULTS Among 296 caregivers included in the dataset, the mean ZBI score was 29.8 (SD = 17.5) out of 88. The typical participant was 62.6 years old (SD = 11.7), female (74.7%), and caring for a mother or father (61.2%). Using multivariate analysis, factors significantly associated with caregiver burden mapped onto: caregiver characteristics (caregivers with higher burden were female, experienced higher decision regret and decisional conflict, preferred that their loved one move into the caregiver's home, into a private nursing home or a mixed private-public nursing home, and had made the decision more recently); relationship characteristics (spouses and children experienced higher burden); and caregiver's perception of social support resources (caregivers who perceived that a joint decision making process had occurred had higher burden). CONCLUSION In line with the proposed framework used, we found that caregiver characteristics, relationship characteristics and caregiver's perception of social support resources were associated with burden of care. Our results will help design interventions to prevent and/or reduce caregivers' burden of care. TRIAL REGISTRATION NCT02244359 . Date of registration: September 18, 2014.
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Affiliation(s)
- Alexandrine Boucher
- Canada Research Chair in Shared Decision Making and Knowledge Translation, and Population Health and Practice-Changing Research Group, Université Laval Primary Care Research Centre (CERSSPL-UL), Quebec, Canada.,Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Canada
| | - Julie Haesebaert
- Canada Research Chair in Shared Decision Making and Knowledge Translation, and Population Health and Practice-Changing Research Group, Université Laval Primary Care Research Centre (CERSSPL-UL), Quebec, Canada.,Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Canada
| | - Adriana Freitas
- Canada Research Chair in Shared Decision Making and Knowledge Translation, and Population Health and Practice-Changing Research Group, Université Laval Primary Care Research Centre (CERSSPL-UL), Quebec, Canada
| | - Rhéda Adekpedjou
- Canada Research Chair in Shared Decision Making and Knowledge Translation, and Population Health and Practice-Changing Research Group, Université Laval Primary Care Research Centre (CERSSPL-UL), Quebec, Canada.,Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Canada
| | - Marjolaine Landry
- Department of Nursing of Université du Québec à Trois-Rivières, Quebec, Canada
| | | | - Dawn Stacey
- Ottawa Hospital Research Institute, Ottawa, Canada.,School of Nursing, University of Ottawa, Ottawa, Canada
| | - Jordie Croteau
- Canada Research Chair in Shared Decision Making and Knowledge Translation, and Population Health and Practice-Changing Research Group, Université Laval Primary Care Research Centre (CERSSPL-UL), Quebec, Canada.,Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Canada
| | - Painchaud-Guérard Geneviève
- Canada Research Chair in Shared Decision Making and Knowledge Translation, and Population Health and Practice-Changing Research Group, Université Laval Primary Care Research Centre (CERSSPL-UL), Quebec, Canada.,Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Canada
| | - France Légaré
- Canada Research Chair in Shared Decision Making and Knowledge Translation, and Population Health and Practice-Changing Research Group, Université Laval Primary Care Research Centre (CERSSPL-UL), Quebec, Canada. .,Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Canada. .,Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale, Pavillon Landry-Poulin, entrée A-1-2, bureau A-4574, 2525, chemin de la Canardière, Quebec, QC, G1J 0A4, Canada.
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12
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Ben Charif A, Croteau J, Adekpedjou R, Zomahoun HTV, Adisso EL, Légaré F. Implementation Research on Shared Decision Making in Primary Care: Inventory of Intracluster Correlation Coefficients. Med Decis Making 2019; 39:661-672. [PMID: 31423898 DOI: 10.1177/0272989x19866296] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Cluster randomized trials are important sources of information on evidence-based practices in primary care. However, there are few sources of intracluster correlation coefficients (ICCs) for designing such trials. We inventoried ICC estimates for shared decision-making (SDM) measures in primary care. Methods. Data sources were studies led by the Canada Research Chair in Shared Decision Making and Knowledge Transition. Eligible studies were conducted in primary care, included at least 2 hierarchical levels, included SDM measures for individual units nested under any type of cluster (area, clinic, or provider), and were approved by an ethics committee. We classified measures into decision antecedents, decision processes, and decision outcomes. We used Bayesian random-effect models to estimate mode ICCs and the 95% highest probability density interval (HPDI). We summarized estimates by calculating median and interquartile range (IQR). Results. Six of 14 studies were included. There were 97 ICC estimates for 17 measures. ICC estimates ranged from 0 to 0.5 (median, 0.03; IRQ, 0-0.07). They were higher for process measures (median, 0.03; IQR, 0-0.07) than for antecedent measures (0.02; 0-0.07) or outcome measures (0.02; 0-0.06), for which, respectively, "decisional conflict" (mode, 0.48; 95% HPDI, 0.39-0.57), "reluctance to disclose uncertainty to patients" (0.5; 0.11-0.89), and "quality of the decision" (0.45; 0.14-0.84) had the highest ICCs. ICCs for provider-level clustering (median, 0.06; IQR, 0-0.13) were higher than for other levels. Limitations. This convenience sample of studies may not reflect all potential ICC ranges for primary care SDM measures. Conclusions. Our inventory of ICC estimates for SDM measures in primary care will improve the ease and accuracy of power calculations in cluster randomized trials and inspire its further expansion in SDM contexts.
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Affiliation(s)
- Ali Ben Charif
- Centre de recherche sur les soins et les services de première ligne, Université Laval, Quebec, QC, Canada.,Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec, QC, Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada.,Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC, Canada
| | - Jordie Croteau
- Centre de recherche sur les soins et les services de première ligne, Université Laval, Quebec, QC, Canada.,Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec, QC, Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada
| | - Rhéda Adekpedjou
- Centre de recherche sur les soins et les services de première ligne, Université Laval, Quebec, QC, Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada
| | - Hervé Tchala Vignon Zomahoun
- Centre de recherche sur les soins et les services de première ligne, Université Laval, Quebec, QC, Canada.,Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec, QC, Canada
| | - Evehouenou Lionel Adisso
- Centre de recherche sur les soins et les services de première ligne, Université Laval, Quebec, QC, Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada
| | - France Légaré
- Centre de recherche sur les soins et les services de première ligne, Université Laval, Quebec, QC, Canada.,Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec, QC, Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada.,Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC, Canada
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Haesebaert J, Adekpedjou R, Croteau J, Robitaille H, Légaré F. Shared decision-making experienced by Canadians facing health care decisions: a Web-based survey. CMAJ Open 2019; 7:E210-E216. [PMID: 30948650 PMCID: PMC6450794 DOI: 10.9778/cmajo.20180202] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Despite health policy that promotes shared decision-making, it is not yet the norm in clinical practice. We aimed to assess how much shared decision-making Canadians experienced in health-related decisions in 2017. METHODS We conducted a cross-sectional online survey in January 2018 with a Web-based panel of Canadians representing all 10 provinces. We assessed their involvement in health-related decisions made with a health care professional over the previous year by asking about 1) discussion of choice of treatment or care plan, 2) presentation of advantages and disadvantages, 3) exploration of ideas and preferences, 4) discussion of preferred option and 5) match between preferred and actual level of participation. We computed an average shared decision-making score (range 1 [never] to 5 [always]). We presented characteristics of participants and responses using descriptive statistics and explored variations across sociodemographic factors, jurisdictions, geographical areas and care settings (home care or not) using multivariate weighted regressions. RESULTS Of the 1591 participants surveyed, 1010 (63.5%) reported receiving health care in the previous 12 months. The mean of the average shared decision-making score was 2.25/5 (standard deviation [SD] 1.16). After weighting, 42.8% of respondents reported that their health care professional often or always mentioned that they had a choice of treatment or care plan, 45.4% reported that advantages and disadvantages were often or always presented, 38.8% reported that they were often or always asked for their ideas or preferences, 40.2% reported that they were often or always asked about their preferred option, and 54.1% stated that their level of participation in decision-making often or always matched their preferred level of participation. Increasing age, rural setting, living in the province of Quebec and not being white significantly decreased the level of shared decision-making experienced. Older respondents (age ≥ 65 yr) receiving home care reported the least shared decision-making (mean score 1.7 [SD 0.5]). INTERPRETATION Canadians in all 10 provinces experienced a low degree of shared decision-making in 2017, with variations across sociodemographic factors, jurisdictions, care settings and geographical areas. Further efforts to foster implementation of shared decision-making are needed and should take these variations into account.
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Affiliation(s)
- Julie Haesebaert
- Centre de recherche sur les soins et services de première ligne de l'Université Laval, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, and Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, Que
| | - Rhéda Adekpedjou
- Centre de recherche sur les soins et services de première ligne de l'Université Laval, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, and Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, Que
| | - Jordie Croteau
- Centre de recherche sur les soins et services de première ligne de l'Université Laval, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, and Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, Que
| | - Hubert Robitaille
- Centre de recherche sur les soins et services de première ligne de l'Université Laval, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, and Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, Que
| | - France Légaré
- Centre de recherche sur les soins et services de première ligne de l'Université Laval, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, and Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, Que.
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Adekpedjou R, Stacey D, Brière N, Freitas A, Garvelink MM, Turcotte S, Menear M, Bourassa H, Fraser K, Durand PJ, Dumont S, Roy L, Légaré F. "Please listen to me": A cross-sectional study of experiences of seniors and their caregivers making housing decisions. PLoS One 2018; 13:e0202975. [PMID: 30161238 PMCID: PMC6117007 DOI: 10.1371/journal.pone.0202975] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 08/13/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Little is known about the decision-making experiences of seniors and informal caregivers facing decisions about seniors' housing decisions when objective decision making measures are used. OBJECTIVES To report on seniors' and caregivers' experiences of housing decisions. DESIGN A cross-sectional study with a quantitative approach supplemented by qualitative data. SETTING Sixteen health jurisdictions providing home care services, Quebec province, Canada. PARTICIPANTS Two separate samples of seniors aged ≥ 65 years and informal caregivers of cognitively impaired seniors who had made a decision about housing. MEASUREMENTS Information on preferred choice and actual choice about housing, role assumed in the decision, decisional conflict and decision regret was obtained through closed-ended questionnaires. Research assistants paraphrased participants' narratives about their decision-making experiences and made other observations in standardized logbooks. RESULTS Thirty-one seniors (median age: 85.5 years) and 48 caregivers (median age: 65.1 years) were recruited. Both seniors and caregivers preferred that the senior stay at home (64.5% and 71.7% respectively). Staying home was the actual choice for only 32.2% of participating seniors and 36.2% of the seniors cared for by the participating caregivers. Overall, 93% seniors and 71% caregivers reported taking an active or collaborative role in the decision-making process. The median decisional conflict score was 23/100 for seniors and 30/100 for caregivers. The median decision regret score was the same for both (10/100). Qualitative analysis revealed that the housing decision was influenced by factors such as seniors' health and safety concerns and caregivers' burden of care. Some caregivers felt sad and guilty when the decision did not match the senior's preference. CONCLUSION The actual housing decision made for seniors frequently did not match their preferred housing option. Advanced care planning regarding housing and better decision support are needed for these difficult decisions.
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Affiliation(s)
- Rhéda Adekpedjou
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Université Laval, Quebec City, Canada
| | - Dawn Stacey
- Ottawa Hospital Research Institute and Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Nathalie Brière
- Centre intégré universitaire en santé et services sociaux de la Capitale-Nationale, Université Laval, Quebec City, Canada
| | - Adriana Freitas
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Université Laval, Quebec City, Canada
| | - Mirjam M. Garvelink
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Université Laval, Quebec City, Canada
| | - Stéphane Turcotte
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Sainte-Marie, Canada
| | - Matthew Menear
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Université Laval, Quebec City, Canada
| | - Henriette Bourassa
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Université Laval, Quebec City, Canada
| | | | | | - Serge Dumont
- Faculty of Social Sciences, Université Laval, Quebec City, Canada
| | - Lise Roy
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Université Laval, Quebec City, Canada
| | - France Légaré
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Université Laval, Quebec City, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada
- * E-mail:
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Légaré F, Adekpedjou R, Stacey D, Turcotte S, Kryworuchko J, Graham ID, Lyddiatt A, Politi MC, Thomson R, Elwyn G, Donner‐Banzhoff N. Interventions for increasing the use of shared decision making by healthcare professionals. Cochrane Database Syst Rev 2018; 7:CD006732. [PMID: 30025154 PMCID: PMC6513543 DOI: 10.1002/14651858.cd006732.pub4] [Citation(s) in RCA: 210] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Shared decision making (SDM) is a process by which a healthcare choice is made by the patient, significant others, or both with one or more healthcare professionals. However, it has not yet been widely adopted in practice. This is the second update of this Cochrane review. OBJECTIVES To determine the effectiveness of interventions for increasing the use of SDM by healthcare professionals. We considered interventions targeting patients, interventions targeting healthcare professionals, and interventions targeting both. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and five other databases on 15 June 2017. We also searched two clinical trials registries and proceedings of relevant conferences. We checked reference lists and contacted study authors to identify additional studies. SELECTION CRITERIA Randomized and non-randomized trials, controlled before-after studies and interrupted time series studies evaluating interventions for increasing the use of SDM in which the primary outcomes were evaluated using observer-based or patient-reported measures. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane.We used GRADE to assess the certainty of the evidence. MAIN RESULTS We included 87 studies (45,641 patients and 3113 healthcare professionals) conducted mainly in the USA, Germany, Canada and the Netherlands. Risk of bias was high or unclear for protection against contamination, low for differences in the baseline characteristics of patients, and unclear for other domains.Forty-four studies evaluated interventions targeting patients. They included decision aids, patient activation, question prompt lists and training for patients among others and were administered alone (single intervention) or in combination (multifaceted intervention). The certainty of the evidence was very low. It is uncertain if interventions targeting patients when compared with usual care increase SDM whether measured by observation (standardized mean difference (SMD) 0.54, 95% confidence interval (CI) -0.13 to 1.22; 4 studies; N = 424) or reported by patients (SMD 0.32, 95% CI 0.16 to 0.48; 9 studies; N = 1386; risk difference (RD) -0.09, 95% CI -0.19 to 0.01; 6 studies; N = 754), reduce decision regret (SMD -0.10, 95% CI -0.39 to 0.19; 1 study; N = 212), improve physical (SMD 0.00, 95% CI -0.36 to 0.36; 1 study; N = 116) or mental health-related quality of life (QOL) (SMD 0.10, 95% CI -0.26 to 0.46; 1 study; N = 116), affect consultation length (SMD 0.10, 95% CI -0.39 to 0.58; 2 studies; N = 224) or cost (SMD 0.82, 95% CI 0.42 to 1.22; 1 study; N = 105).It is uncertain if interventions targeting patients when compared with interventions of the same type increase SDM whether measured by observation (SMD 0.88, 95% CI 0.39 to 1.37; 3 studies; N = 271) or reported by patients (SMD 0.03, 95% CI -0.18 to 0.24; 11 studies; N = 1906); (RD 0.03, 95% CI -0.02 to 0.08; 10 studies; N = 2272); affect consultation length (SMD -0.65, 95% CI -1.29 to -0.00; 1 study; N = 39) or costs. No data were reported for decision regret, physical or mental health-related QOL.Fifteen studies evaluated interventions targeting healthcare professionals. They included educational meetings, educational material, educational outreach visits and reminders among others. The certainty of evidence is very low. It is uncertain if these interventions when compared with usual care increase SDM whether measured by observation (SMD 0.70, 95% CI 0.21 to 1.19; 6 studies; N = 479) or reported by patients (SMD 0.03, 95% CI -0.15 to 0.20; 5 studies; N = 5772); (RD 0.01, 95%C: -0.03 to 0.06; 2 studies; N = 6303); reduce decision regret (SMD 0.29, 95% CI 0.07 to 0.51; 1 study; N = 326), affect consultation length (SMD 0.51, 95% CI 0.21 to 0.81; 1 study, N = 175), cost (no data available) or physical health-related QOL (SMD 0.16, 95% CI -0.05 to 0.36; 1 study; N = 359). Mental health-related QOL may slightly improve (SMD 0.28, 95% CI 0.07 to 0.49; 1 study, N = 359; low-certainty evidence).It is uncertain if interventions targeting healthcare professionals compared to interventions of the same type increase SDM whether measured by observation (SMD -0.30, 95% CI -1.19 to 0.59; 1 study; N = 20) or reported by patients (SMD 0.24, 95% CI -0.10 to 0.58; 2 studies; N = 1459) as the certainty of the evidence is very low. There was insufficient information to determine the effect on decision regret, physical or mental health-related QOL, consultation length or costs.Twenty-eight studies targeted both patients and healthcare professionals. The interventions used a combination of patient-mediated and healthcare professional directed interventions. Based on low certainty evidence, it is uncertain whether these interventions, when compared with usual care, increase SDM whether measured by observation (SMD 1.10, 95% CI 0.42 to 1.79; 6 studies; N = 1270) or reported by patients (SMD 0.13, 95% CI -0.02 to 0.28; 7 studies; N = 1479); (RD -0.01, 95% CI -0.20 to 0.19; 2 studies; N = 266); improve physical (SMD 0.08, -0.37 to 0.54; 1 study; N = 75) or mental health-related QOL (SMD 0.01, -0.44 to 0.46; 1 study; N = 75), affect consultation length (SMD 3.72, 95% CI 3.44 to 4.01; 1 study; N = 36) or costs (no data available) and may make little or no difference to decision regret (SMD 0.13, 95% CI -0.08 to 0.33; 1 study; low-certainty evidence).It is uncertain whether interventions targeting both patients and healthcare professionals compared to interventions of the same type increase SDM whether measured by observation (SMD -0.29, 95% CI -1.17 to 0.60; 1 study; N = 20); (RD -0.04, 95% CI -0.13 to 0.04; 1 study; N = 134) or reported by patients (SMD 0.00, 95% CI -0.32 to 0.32; 1 study; N = 150 ) as the certainty of the evidence was very low. There was insuffient information to determine the effects on decision regret, physical or mental health-related quality of life, or consultation length or costs. AUTHORS' CONCLUSIONS It is uncertain whether any interventions for increasing the use of SDM by healthcare professionals are effective because the certainty of the evidence is low or very low.
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Affiliation(s)
- France Légaré
- Université LavalCentre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL‐UL)2525, Chemin de la CanardièreQuebecQuébecCanadaG1J 0A4
| | - Rhéda Adekpedjou
- Université LavalDepartment of Social and Preventive MedicineQuebec CityQuebecCanada
| | - Dawn Stacey
- University of OttawaSchool of Nursing451 Smyth RoadOttawaONCanada
| | - Stéphane Turcotte
- Centre de Recherche du CHU de Québec (CRCHUQ) ‐ Hôpital St‐François d'Assise10 Rue de l'Espinay, D6‐727Québec CityQCCanadaG1L 3L5
| | - Jennifer Kryworuchko
- The University of British ColumbiaSchool of NursingT201 2211 Wesbrook MallVancouverBritish ColumbiaCanadaV6T 2B5
| | - Ian D Graham
- University of OttawaSchool of Epidemiology, Public Health and Preventative Medicine600 Peter Morand CrescentOttawaONCanada
| | - Anne Lyddiatt
- No affiliation28 Greenwood RoadIngersollONCanadaN5C 3N1
| | - Mary C Politi
- Washington University School of MedicineDivision of Public Health Sciences, Department of Surgery660 S Euclid AveSt LouisMissouriUSA63110
| | - Richard Thomson
- Newcastle UniversityInstitute of Health and SocietyBaddiley‐Clark BuildingRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Glyn Elwyn
- Cardiff UniversityCochrane Institute of Primary Care and Public Health, School of Medicine2nd Floor, Neuadd MeirionnyddHeath ParkCardiffWalesUKCF14 4YS
| | - Norbert Donner‐Banzhoff
- University of MarburgDepartment of Family Medicine / General PracticeKarl‐von‐Frisch‐Str. 4MarburgGermanyD‐35039
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Menear M, Garvelink MM, Adekpedjou R, Perez MMB, Robitaille H, Turcotte S, Légaré F. Factors associated with shared decision making among primary care physicians: Findings from a multicentre cross-sectional study. Health Expect 2017; 21:212-221. [PMID: 28768060 PMCID: PMC5750688 DOI: 10.1111/hex.12603] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Despite growing recognition that shared decision making (SDM) is central for patient-centred primary care, adoption by physicians remains limited in routine practice. OBJECTIVE To examine the characteristics of physicians, patients and consultations associated with primary care physicians' SDM behaviours during routine care. METHODS A multicentre cross-sectional survey study was conducted with 114 unique patient-physician dyads recruited from 17 primary care clinics in Quebec and Ontario, Canada. Physicians' SDM behaviours were assessed with the 12-item OPTION scale scored by third observers using audio-recordings of consultations. Independent variables included 21 physician, patient and consultation characteristics. We assessed factors associated with OPTION scores using multivariate linear regression models. RESULTS On the OPTION scale, where higher scores indicated greater SDM behaviours, physicians earned an overall mean score of 25.7±9.8 of 100. In the final adjusted regression model, higher OPTION scores were associated with physicians' social participation (involvement in one committee β=5.75, P=.04; involvement in two or more committees β=7.74, P=.01), patients' status as employed (β=6.48, P=.02), clinically significant decisional conflict in patients (β=7.15, P=.002) and a longer duration of consultations (β=0.23, P=.002). CONCLUSION Physicians' social participation, patients' employment status and decisional conflict and the duration of consultations were associated with primary care physicians' SDM behaviours in routine care. These factors should be considered when designing strategies to implement SDM and promote more patient-centred care in primary care.
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Affiliation(s)
- Matthew Menear
- CHU de Québec Research Centre, Quebec, QC, Canada.,Department of Family Medicine and Emergency Medicine, Laval University, Quebec, QC, Canada
| | | | - Rhéda Adekpedjou
- CHU de Québec Research Centre, Quebec, QC, Canada.,Department of Social and Preventive Medicine, Laval University, Quebec, QC, Canada
| | | | | | | | - France Légaré
- CHU de Québec Research Centre, Quebec, QC, Canada.,Department of Family Medicine and Emergency Medicine, Laval University, Quebec, QC, Canada
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Diouf NT, Ben Charif A, Adisso L, Adekpedjou R, Zomahoun HTV, Agbadjé TT, Dogba MJ, Garvelink MM. Shared decision making in West Africa: The forgotten area. Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen 2017; 123-124:7-11. [DOI: 10.1016/j.zefq.2017.05.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Dion M, Diouf NT, Robitaille H, Turcotte S, Adekpedjou R, Labrecque M, Cauchon M, Légaré F. Teaching Shared Decision Making to Family Medicine Residents: A Descriptive Study of a Web-Based Tutorial. JMIR Med Educ 2016; 2:e17. [PMID: 27993760 PMCID: PMC5206485 DOI: 10.2196/mededu.6442] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 12/05/2016] [Accepted: 12/07/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND DECISION+2, a Web-based tutorial, was designed to train family physicians in shared decision making (SDM) regarding the use of antibiotics for acute respiratory infections (ARIs). It is currently mandatory for second-year family medicine residents at Université Laval, Quebec, Canada. However, little is known about how such tutorials are used, their effect on knowledge scores, or how best to assess resident participation. OBJECTIVE The objective of our study was to describe the usage of this Web-based training platform by family medicine residents over time, evaluate its effect on their knowledge scores, and identify what kinds of data are needed for a more comprehensive analysis of usage and knowledge acquisition. METHODS We identified, collected, and analyzed all available data about participation in and current usage of the tutorial and its before-and-after 10-item knowledge test. Residents were separated into 3 log-in periods (2012-2013, 2013-2014, and 2014-2015) depending on the day of their first connection. We compared residents' participation rates between entry periods (Cochran-Armitage test), assessed the mean rank of the difference in total scores and category scores between pre- and posttest (Wilcoxon signed-rank test), and compared frequencies of each. Subsequent to analyses, we identified types of data that would have provided a more complete picture of the usage of the program and its effect on knowledge scores. RESULTS The tutorial addresses 3 knowledge categories: diagnosing ARIs, treating ARIs, and SDM regarding the use of antibiotics for treating ARIs. From July 2012 to July 2015, all 387 second-year family medicine residents were eligible to take the Web-based tutorial. Out of the 387 eligible residents, 247 (63.8%) logged in at least once. Their participation rates varied between entry periods, most significantly between the 2012-2013 and 2013-2014 cohorts (P=.006). For the 109 out of 387 (28.2%) residents who completed the tutorial and both tests, total and category scores significantly improved between pre- and posttest (all P values <.001). However, the frequencies of those answering correctly on 2 of the 3 SDM questions did not increase significantly (P>.99, P=.25). Distribution of pre- or posttest total and category scores did not increase between entry periods (all P values >.1). Available data were inadequate for evaluating the associations between the tutorial and its impact on the residents' scores and therefore could tell us little about its effect on increasing their knowledge. CONCLUSION Residents' use of this Web-based tutorial appeared to increase between entry periods following the changes to the SDM program, and the tutorial seemed less effective for increasing SDM knowledge scores than for diagnosis or treatment scores. However, our results also highlight the need to improve data availability before participation in Web-based SDM tutorials can be properly evaluated or knowledge scores improved.
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Affiliation(s)
- Maxime Dion
- Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Saint-François-d'Assise Hospital, Quebec, QC, Canada
- Department of Mathematics and Statistics, Université Laval, Quebec, QC, Canada
| | - Ndeye Thiab Diouf
- Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Saint-François-d'Assise Hospital, Quebec, QC, Canada
- Department of Community Health, Université Laval, Quebec, QC, Canada
| | - Hubert Robitaille
- Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Saint-François-d'Assise Hospital, Quebec, QC, Canada
| | - Stéphane Turcotte
- Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Saint-François-d'Assise Hospital, Quebec, QC, Canada
| | - Rhéda Adekpedjou
- Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Saint-François-d'Assise Hospital, Quebec, QC, Canada
- Department of Social and Preventive Medicine, Université Laval, Quebec, QC, Canada
| | - Michel Labrecque
- Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Saint-François-d'Assise Hospital, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC, Canada
| | - Michel Cauchon
- Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Saint-François-d'Assise Hospital, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC, Canada
| | - France Légaré
- Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Saint-François-d'Assise Hospital, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC, Canada
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