An interprofessional approach to shared decision making: an exploratory case study with family caregivers of one IP home care team

BMC Geriatrics

Renée Drolet⁴  Sophie Desroches⁵  Marie-Claude Lord³  Hubert Robitaille⁴  Nathalie Brière²  Dawn Stacey¹  France Légaré⁶ 

[1] Ottawa Hospital Research Institute, Ottawa, Canada;Centre de santé et de services sociaux de la Vieille-Capitale, Quebec City, Canada;Centre de santé et de services sociaux de Montmagny-L’Islet, Montmagny, Canada;Research Centre of the Centre Hospitalier Universitaire de Québec, Hôpital Saint-François d’Assise, 10 de L’Espinay, Room D6-735, Quebec City G1L 3 L5, Canada;Department of Food Science and Nutrition, Université Laval, Quebec City, Canada;Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, Canada

关键词: Family caregivers;    Case study;    Qualitative methods;    Older adults;    Home care;    Interprofessionalism;    Shared decision making;   

Others  :  856536
DOI  :  10.1186/1471-2318-14-83

 received in 2014-02-24, accepted in 2014-06-23,  发布年份 2014

【 摘 要 】

Background

Within the context of an exploratory case study, the authors assessed the perceptions of family caregivers about the decision-making process regarding relocating their relative and about the applicability of an interprofessional approach to shared decision making (IP-SDM). They also assessed perceptions of health professionals and health managers about IP-SDM.

Methods

From November 2010 to October 2011, we worked with one IP home care team dedicated to older adults (the case) from a large primary health care organization in Quebec City, Canada. We identified six of their clients who had faced a decision about whether to stay at home or move to a long-term care facility in the past year and interviewed their family caregivers. We explored the decision-making process they had experienced regarding relocating their relative and their perceptions about the applicability of IP-SDM in this context. Attitudes towards IP-SDM and potential barriers to this approach were explored using a focus group with the participating IP home care team, individual interviews with 8 managers and a survey of 272 health professionals from the primary care organization. A hybrid process of inductive and deductive thematic analysis was used and data were triangulated across all sources.

Results

Family caregivers reported lack of agreement on the nature of the decision to be made, a disconnection between home care services and relatives’ needs, and high cost of long-term care alternatives. Factors influencing their decision included their ability to provide care for their relative. While they felt somewhat supported by the IP home care team, they also felt pressured in the decision. Overall, they did not perceive they had been exposed to IP-SDM but agreed that it was applicable in this context. Results from the survey, focus group and interviews with health professionals and managers indicated they all had a favourable attitude towards IP-SDM but many barriers hampered its implementation in their practice.

Conclusions

The family caregivers in this study did not experience IP-SDM when relocating their relative. Added to results obtained with health professionals and managers, this highlights the need for an effective intervention targeting identified barriers to implementing IP-SDM in this context.

【 授权许可】

   
2014 Légaré et al.; licensee BioMed Central Ltd.

【 图 表 】

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