In 2022, the article “Shared Decision-Making Training for Home Care Teams to Engage Frail Older Adults and Caregivers in Housing Decisions: Stepped-Wedge Cluster Randomized Trial” was published. France Légaré, Scientific Director of the Université Laval branch of the Change Management axis of our unit, is a member of the writing team.
- Évèhouénou Lionel Adisso
- Monica Taljaard
- Dawn Stacey
- Nathalie Brière
- Hervé Tchala Vignon Zomahoun
- Pierre Jacob Durand
- Louis-Paul Rivest
- France Légaré
Adisso ÉL, Taljaard M, Stacey D, Brière N, Zomahoun HTV, Durand PJ, Rivest L-P, Légaré F. Shared Decision-Making Training for Home Care Teams to Engage Frail Older Adults and Caregivers in Housing Decisions: Stepped-Wedge Cluster Randomized Trial. JMIR Aging. DOI: 10.2196/38419
Context
Frail older adults and their caregivers often face complex decisions regarding their living arrangements, such as whether to remain at home or move to a residence. Home care teams, often overwhelmed, lack the time and resources to provide structured decision support. This study explores whether distributing a decision aid alone is sufficient to support these decisions, or if shared decision-making training is necessary.
Method
A stepped-wedge cluster randomized trial was conducted with home care teams in nine health centers across Quebec. The intervention included a 1.5-hour online tutorial and a 3.5-hour interactive workshop on interprofessional shared decision-making, using a decision guide. The control group received only the guide. The primary outcome was active participation in decision-making, measured using the Control Preferences Scale. Secondary outcomes included decisional conflict and perceived involvement by care teams. An intention-to-treat analysis was performed.
Results
The analysis included 311 older adults (average age: 81.2 years) and 339 caregivers (average age: 66.4 years). The intervention increased active participation in decision-making by 3.3% for older adults and 6.1% for caregivers. No significant effects were observed for secondary outcomes. However, perceived involvement by professionals slightly increased (+5.4 points), and decisional conflict among caregivers decreased by 7.5%.
Conclusion
Shared decision-making training did not show a significantly greater effect than simply distributing a decision guide in supporting housing decisions. However, it contributed to a slight reduction in decisional conflict among caregivers and improved perceived involvement of older adults.