Does Adding Training in Shared Decision Making for Home Care Teams to Providing Decision Guides Better Engage Frail Elders and Caregivers in Housing Decisions? :A Stepped-Wedge Cluster Randomized Trial

JMIR Aging. 2022 Jun 27. doi: 10.2196/39386. Online ahead of print.


BACKGROUND: One of the toughest decisions frequently faced by frail elders is to remain at home, with or without assistance, or move into residential care. Frail elders and caregivers need support from their home care teams in making this difficult housing decision. However, home care teams are often understaffed, and busy, shared decision-making (SDM) training is costly, and overall awareness of SDM is increasing. We hypothesized that, distributing a decision aid could be sufficient for providing decision support without the addition of SDM training for home care teams.

OBJECTIVE: We evaluated the effectiveness of adding web-based training and workshops for care teams in interprofessional shared decision-making (IP-SDM) to passive dissemination of a decision guide on the proportion of frail elders or caregivers of cognitively-impaired frail elders reporting active roles in housing decision-making.

METHODS: We conducted a stepped-wedge cluster randomized trial with home care teams in nine health centers in Quebec, Canada. Participants were frail elders or caregivers of cognitively-impaired frail elders facing housing decisions and receiving care from a home care team of one of the participating health centers. The intervention consisted of a 1.5-hour web-based tutorial for home care teams plus a 3.5-hour interactive workshop in interprofessional SDM using a decision guide, designed to support frail elders and caregivers in making housing decisions. The control was passive dissemination of the decision guide. The primary outcome was an active role in decision-making, among frail elders and caregivers, measured using the Control Preferences Scale. Secondary outcomes included decisional conflict and perceptions of how much care teams involved frail elders and caregivers in decision-making. We performed intention-to-treat analysis.

RESULTS: A total of 311 frail elders were included in the analysis: (208 [66.9%] female; mean [SD] age, 81.2[7.5] years; 183 [58.8%] secondary school level or higher) and 339 caregivers of cognitively-impaired frail elders (239 [70.5%] female; mean age, 66.4[11.7] years; 269 [87.3%] secondary school level or higher). After adjusting for clustering, time effects and prespecified covariates, the intervention increased the proportion of frail elders reporting active roles in decision-making by 3.3% (95% CI -5.8% to 12.4%; P=.47) and the proportion of caregivers of cognitively-impaired frail elders by 6.1% (95% CI -11.2% to 23.4%; P=.49). There was no significant impact on secondary outcomes. However, the mean score of frail elders’ perception of how much health professionals involved them in decision-making increased by 5.4 (95% CI – 0.6 to 11.4); P= .07 and the proportion of caregivers who reported decisional conflict decreased by 7.5% (95% CI – 16.5% to 1.6%); P= .10.

CONCLUSIONS: Although it slightly reduced decisional conflict for caregivers, SDM training did not equip home care teams significantly better than provision of a decision aid for involving frail elders and their caregivers in decision-making.

CLINICALTRIAL: Trial Registration identifier: NCT02592525.

PMID:35759791 | DOI:10.2196/39386

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