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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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Boland L, Légaré F, Perez MMB, Menear M, Garvelink MM, McIsaac DI, Painchaud Guérard G, Emond J, Brière N, Stacey D. Impact of home care versus alternative locations of care on elder health outcomes: an overview of systematic reviews. BMC Geriatr 2017; 17:20. [PMID: 28088166 PMCID: PMC5237488 DOI: 10.1186/s12877-016-0395-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [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: 05/18/2016] [Accepted: 12/09/2016] [Indexed: 01/08/2023] Open
Abstract
Background Many elders struggle with the decision to remain at home or to move to an alternative location of care. A person’s location of care can influence health and wellbeing. Healthcare organizations and policy makers are increasingly challenged to better support elders’ dwelling and health care needs. A summary of the evidence that examines home care compared to other care locations can inform decision making. We surveyed and summarized the evidence evaluating the impact of home care versus alternative locations of care on elder health outcomes. Methods We conducted an overview of systematic reviews. Data sources included MEDLINE, the Cochrane Library, EMBASE, and CINAHL. Eligible reviews included adults 65+ years, elder home care, alternative care locations, and elder health outcomes. Two independent reviewers screened citations. We extracted data and appraised review quality using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) checklist. Results were synthesized narratively. Results The search yielded 2575 citations, of which 19 systematic reviews were eligible. Three hundred and forty studies with 271,660 participants were synthesized across the systematic reviews. The categories of comparisons included: home with support versus independent living at home (n = 11 reviews), home care versus institutional care (n = 3 reviews), and rehabilitation at home versus conventional rehabilitation services (n = 7 reviews). Two reviews had data relevant to two categories. Most reviews favoured home with support to independent living at home. Findings comparing home care to institutional care were mixed. Most reviews found no differences in health outcomes between rehabilitation at home versus conventional rehabilitation services. Systematic review quality was moderate, with a median AMSTAR score of 6 (range 4 - 10 out of 11). Conclusions The evidence on the impact of home care compared to alternative care locations on elder health outcomes is heterogeneous. Our findings support positive health impacts of home support interventions for community dwelling elders compared to independent living at home. There is insufficient evidence to determine the impact of alternative care locations on elders’ health. Additional research targeting housing and care options for the elderly is needed. Electronic supplementary material The online version of this article (doi:10.1186/s12877-016-0395-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Laura Boland
- Population Health, Faculty of Health Sciences, University of Ottawa, 25 University Private, Ottawa, ON, K1N 7 K4, Canada
| | - France Légaré
- CHU de Québec Research Centre-Université Laval site Hôpital St-Francois d'Assise, 10 Rue Espinay, Quebec, G1L 3 L5, Canada.
| | - Maria Margarita Becerra Perez
- CHU de Québec Research Centre-Université Laval site Hôpital St-Francois d'Assise, 10 Rue Espinay, Quebec, G1L 3 L5, Canada
| | - Matthew Menear
- CHU de Québec Research Centre-Université Laval site Hôpital St-Francois d'Assise, 10 Rue Espinay, Quebec, G1L 3 L5, Canada
| | - Mirjam Marjolein Garvelink
- CHU de Québec Research Centre-Université Laval site Hôpital St-Francois d'Assise, 10 Rue Espinay, Quebec, G1L 3 L5, Canada
| | - Daniel I McIsaac
- Department of Anesthesiology, Faculty of Medicine University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Rm B311, Ottawa, ON, K1Y 4E9, Canada
| | - Geneviève Painchaud Guérard
- CHU de Québec Research Centre-Université Laval site Hôpital St-Francois d'Assise, 10 Rue Espinay, Quebec, G1L 3 L5, Canada
| | - Julie Emond
- Centre de santé et de services sociaux de la Vieille-Capitale, 880, rue Père-Marquette, Québec, G1M 2R9, Canada
| | - Nathalie Brière
- Centre intégré universitaire en santé et services sociaux de la Capitale-Nationale, 880, rue Père-Marquette, Québec, G1M 2R9, Canada
| | - Dawn Stacey
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.,University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8 M5, Canada
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Garvelink MM, Emond J, Menear M, Brière N, Freitas A, Boland L, Perez MMB, Blair L, Stacey D, Légaré F. Development of a decision guide to support the elderly in decision making about location of care: an iterative, user-centered design. Res Involv Engagem 2016; 2:26. [PMID: 29062524 PMCID: PMC5611600 DOI: 10.1186/s40900-016-0040-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 06/18/2016] [Indexed: 06/07/2023]
Abstract
PLAIN ENGLISH SUMMARY For the elderly to get the care and services they need, they may need to make the difficult decision about staying in their home or moving to another home. Many other people may be involved in their care too (friends, family and healthcare providers), and can support them in making the decision. We asked informal caregivers of elderly people to help us develop a decision guide to support them and their loved ones in making this decision. This guide will be used by health providers in home care who are trained to help people make decisions. The guide is in French and English. To design and test this decision guide we involved elderly people, their caregivers and health administrators. We first asked them what they needed for making the decision, and then designed a first version of the guide. Then we asked them to look at it and give feedback, which was used to make the final version. We then used scientific criteria to check its content and the language used. The final decision guide was acceptable to the caregivers, their elderly loved ones, and the health administrators. The guide is currently being evaluated in a large research project with home care teams in the province of Quebec. ABSTRACT Background As they grow older, many elderly people are faced with the difficult and preference-sensitive decision about staying in their home or moving to a residence better adapted to their evolving care needs. We aimed to develop an English and French decision aid (DA) for elderly people facing this decision, and to involve end-users in all phases of the development process. Methods A three-cycle design with involvement of end-users in Quebec. End-users were elderly people (n = 4) caregivers of the elderly (n = 5), health administrators involved in home-care service delivery or policy (n = 6) and an interprofessional research team (n = 19). Cycle 1: Decisional needs assessment and development of the first prototype based on existing tools and input from end-users; overview of reviews examining the impact of location of care on elderly people's health outcomes. Cycle 2: Usability testing with end-users, adaptation of prototype. Cycle 3: Refinement of the prototype with a linguist, graphic designer and end-users. The final prototype underwent readability testing and an International Patient Decision Aids (IPDAS) criteria compatibility assessment to verify minimal requirements for decision aids and was tested for usability by the elderly. ResultsCycle 1: We used the Ottawa Personal Decision Guide to design a first prototype. As the overview of reviews did not find definitive evidence regarding optimal locations of care for elderly people, we were not able to add evidence-based advantages and disadvantages to the guide. Cycle 2: Overall, the caregivers and health administrators who evaluated the prototype (n = 10) were positive. In response to their suggestions, we deleted some elements (overview of pros, cons, and consequences of the options) that were necessary to qualify the tool as a DA and renamed it a "decision guide". Cycle 3: We developed French and English versions of the guide, readable at a primary school level. The elderly judged the guide as acceptable. Conclusion We developed a decision guide to support elderly people and their caregivers in decision making about location of care. This paper is one of few to report on a fully collaborative approach to decision guide development that involves end-users at every stage (caregivers and health administrators early on, the frail elderly in the final stages). The guide is currently being evaluated in a cluster randomized trial. Trial registration: NCT02244359.
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Affiliation(s)
- Mirjam M. Garvelink
- CHU de Québec Research Centre - Hôpital St-Francois d’Assise, 10 Rue Espinay, Quebec City, QC G1L 3L5 Canada
| | - Julie Emond
- Centre de santé et de services sociaux de la Vieille-Capitale, 880, rue Père-Marquette, Quebec City, QC G1M 2R9 Canada
| | - Matthew Menear
- CHU de Québec Research Centre - Hôpital St-Francois d’Assise, 10 Rue Espinay, Quebec City, QC G1L 3L5 Canada
| | - Nathalie Brière
- Centre de santé et de services sociaux de la Vieille-Capitale, 880, rue Père-Marquette, Quebec City, QC G1M 2R9 Canada
| | - Adriana Freitas
- CHU de Québec Research Centre - Hôpital St-Francois d’Assise, 10 Rue Espinay, Quebec City, QC G1L 3L5 Canada
| | - Laura Boland
- Ottawa Hospital Research Institute, 725 Parkdale Ave., Ottawa, ON K1Y 4E9 Canada
| | | | - Louisa Blair
- CHU de Québec Research Centre - Hôpital St-Francois d’Assise, 10 Rue Espinay, Quebec City, QC G1L 3L5 Canada
| | - Dawn Stacey
- Ottawa Hospital Research Institute, 725 Parkdale Ave., Ottawa, ON K1Y 4E9 Canada
- University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5 Canada
| | - France Légaré
- CHU de Québec Research Centre - Hôpital St-Francois d’Assise, 10 Rue Espinay, Quebec City, QC G1L 3L5 Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, 1050, Ave de la Médecine, Pavillon Ferdinand-Vandry, Quebec City, QC G1V 0A6 Canada
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Leiva Portocarrero ME, Garvelink MM, Becerra Perez MM, Giguère A, Robitaille H, Wilson BJ, Rousseau F, Légaré F. Decision aids that support decisions about prenatal testing for Down syndrome: an environmental scan. BMC Med Inform Decis Mak 2015; 15:76. [PMID: 26404088 PMCID: PMC4583147 DOI: 10.1186/s12911-015-0199-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 09/16/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Prenatal screening tests for Down syndrome (DS) are routine in many developed countries and new tests are rapidly becoming available. Decisions about prenatal screening are increasingly complex with each successive test, and pregnant women need information about risks and benefits as well as clarity about their values. Decision aids (DAs) can help healthcare providers support women in this decision. Using an environmental scan, we aimed to identify publicly available DAs focusing on prenatal screening/diagnosis for Down syndrome that provide effective support for decision making. METHODS Data sources searched were the Decision Aids Library Inventory (DALI) of the Ottawa Patient Decision Aids Research Group at the Ottawa Health Research Institute; Google searches on the internet; professional organizations, academic institutions and other experts in the field; and references in existing systematic reviews on DAs. Eligible DAs targeted pregnant women, focused on prenatal screening and/or diagnosis, applied to tests for fetal abnormalities or aneuploidies, and were in French, English, Spanish or Portuguese. Pairs of reviewers independently identified eligible DAs and extracted characteristics including the presence of practical decision support tools and features to aid comprehension. They then performed quality assessment using the 16 minimum standards established by the International Patient Decision Aids Standards (IPDASi v4.0). RESULTS Of 543 potentially eligible DAs (512 in DALI, 27 from experts, and four on the internet), 23 were eligible and 20 were available for data extraction. DAs were developed from 1996 to 2013 in six countries (UK, USA, Canada, Australia, Sweden, and France). Five DAs were for prenatal screening, three for prenatal diagnosis and 12 for both). Eight contained values clarification methods (personal worksheets). The 20 DAs scored a median of 10/16 (range 6-15) on the 16 IPDAS minimum standards. DISCUSSION None of the 20 included DAs met all 16 IPDAS minimum standards, and few included practical decision support tools or aids to comprehension. CONCLUSIONS Our results indicate there is a need for DAs that effectively support decision making regarding prenatal testing for Down syndrome, especially in light of the recently available non-invasive prenatal screening tests.
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Affiliation(s)
- Maria Esther Leiva Portocarrero
- />Research Axis of Population Health and Practice-Changing Research, CHU de Québec Research Centre, Saint-François-d’Assise Hospital, 10, rue de l’Espinay, Quebec, QC G1L 3L5 Canada
| | - Mirjam M Garvelink
- />Research Axis of Population Health and Practice-Changing Research, CHU de Québec Research Centre, Saint-François-d’Assise Hospital, 10, rue de l’Espinay, Quebec, QC G1L 3L5 Canada
| | - Maria Margarita Becerra Perez
- />Research Axis of Population Health and Practice-Changing Research, CHU de Québec Research Centre, Saint-François-d’Assise Hospital, 10, rue de l’Espinay, Quebec, QC G1L 3L5 Canada
| | - Anik Giguère
- />Centre d’excellence sur le vieillissement de Québec, CHU de Québec Research Centre, Saint-François-d’Assise Hospital, 10, rue de l’Espinay, Quebec, QC G1L 3L5 Canada
- />Department of Family Medicine and Emergency Medicine, Pavillon Ferdinand-Vandry, Université Laval, 1050, avenue de la Médecine, Quebec, QC G1V 0A6 Canada
| | - Hubert Robitaille
- />Research Axis of Population Health and Practice-Changing Research, CHU de Québec Research Centre, Saint-François-d’Assise Hospital, 10, rue de l’Espinay, Quebec, QC G1L 3L5 Canada
| | - Brenda J. Wilson
- />Department of Epidemiology and Community Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5 Canada
| | - François Rousseau
- />Department of Molecular biology, Medical Biochemistry and Pathology, Faculty of Medicine, Pavillon Ferdinand-Vandry, Université Laval, 1050, avenue de la Médecine, Quebec, QC G1V 0A6 Canada
- />MSSS/FRQS/CHUQ Research Chair in Health Technology Assessment and Evidence-based Laboratory Medicine, Saint-François-d’Assise Hospital, 10, rue de l’Espinay, Quebec, QC G1L 3L5 Canada
| | - France Légaré
- />Research Axis of Population Health and Practice-Changing Research, CHU de Québec Research Centre, Saint-François-d’Assise Hospital, 10, rue de l’Espinay, Quebec, QC G1L 3L5 Canada
- />Department of Family Medicine and Emergency Medicine, Pavillon Ferdinand-Vandry, Université Laval, 1050, avenue de la Médecine, Quebec, QC G1V 0A6 Canada
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