Shared decision making with frail older patients: Proposed teaching framework and practice recommendations

Pol, Marjolein van de; Fluit, Cornelia; Lagro, Joep; Slaats, Yvonne; Rikkert, Marcel G M Olde; Lagro-Janssen, Antoine L. M.

doi:10.1080/02701960.2016.1276014

Cited by 43 publications

(51 citation statements)

References 63 publications

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“…After training, patients received a geriatric screening including discussion of patients’ life goals and treatment goals, which at least somewhat prepared patients for the consultation with their surgeon. 28 , 29 Learning opportunities were optimal since our training was based on practice-based learning 13 , 38 and comprised a short workshop including role plays with an actor and training-on-the-job. 39 …”

Section: Discussionmentioning

confidence: 99%

“… 9 , 10 In addition, specific geriatric training in surgical curricula is minimal or lacking, 11 and there is room for improvement in implementing basic geriatrics. 12 , 13 Moreover, to involve patients in decision-making and deliver patient-preferred care, shared decision-making (SDM) and shared goal-setting are widely recommended for surgical procedures in these frail patients where alternatives for a major operation are available. 3 , 14 , 15 Previous studies show that surgeons’ SDM skills can be optimized 16 , 17 specifically among older patients.…”

Section: Introductionmentioning

confidence: 99%

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Training surgeons in shared decision-making with cancer patients aged 65 years and older: a pilot study

Geessink¹,

Schoon²,

Rikkert³

et al. 2017

CMAR

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ObjectiveTreatment decision-making in older patients with colorectal (CRC) or pancreatic cancer (PC) needs improvement. We introduced the EASYcare in Geriatric Onco-surgery (EASY-GO) intervention to optimize the shared decision-making (SDM) process among these patients.MethodsThe EASY-GO intervention comprised a working method with geriatric assessment and SDM training for surgeons. A non-equivalent control group design was used. Newly diagnosed CRC/PC patients aged ≥65 years were included. Primary patient-reported experiences were the quality of SDM (SDM-Q-9, range 0–100), involvement in decision-making (Visual Analog Scale for Involvement in the decision-making process [range 0–10]), satisfaction about decision-making (Visual Analog Scale for Satisfaction concerning the decision-making process [range 0–10]), and decisional regret (Decisional Regret Scale [DRS], range 0–100). Only for DRS, lower scores are better.ResultsA total of 71.4% of the involved consultants and 42.9% of the involved residents participated in the EASY-GO training. Only 4 trained surgeons consulted patients both before (n=19) and after (n=19) training and were consequently included in the analyses. All patient-reported experience measures showed a consistent but non-significant change in the direction of improved decision-making after training. According to surgeons, decisions were significantly more often made together with the patient after training (before, 38.9% vs after, 73.7%, p=0.04). Sub-analyses per diagnosis showed that patient experiences among older PC patients consistent and clinically relevant changed in the direction of improved decision-making after training (SDM-Q-9 +13.4 [95% CI −7.9; 34.6], VAS-I +0.27 [95% CI −1.1; 1.6], VAS-S +0.88 [95% CI −0.5; 2.2], DRS −10.3 [95% CI −27.8; 7.1]).ConclusionThis pilot study strengthens the practical potential of the intervention’s concept among older surgical cancer patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Training surgeons in shared decision-making with cancer patients aged 65 years and older: a pilot study

Geessink¹,

Schoon²,

Rikkert³

et al. 2017

CMAR

View full text Add to dashboard Cite

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“…To improve the timely initiation of ACP, GPs need training [ 32 , 67 ]. As a key message, we suggest that people with dementia participate in ACP when future care is planned in light of their goals, life values, normal daily function, and their remaining QoL [ 41 , 46 , 67 ]. A recently published dynamic model for shared decision making with frail elderly could be used for this purpose [ 65 ].…”

Section: Implications For Practicementioning

confidence: 99%

Barriers and facilitators for GPs in dementia advance care planning: A systematic integrative review

et al. 2018

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BackgroundDue to the disease’s progressive nature, advance care planning (ACP) is recommended for people with early stage dementia. General practitioners (GPs) should initiate ACP because of their longstanding relationships with their patients and their early involvement with the disease, however ACP is seldom applied.AimTo determine the barriers and facilitators faced by GPs related to ACP with people with dementia.Data sourcesWe systematically searched the relevant databases for papers published between January 1995 and December 2016, using the terms: primary healthcare, GP, dementia, and ACP. We conducted a systematic integrative review following Whittemore and Knafl’s method. Papers containing empirical data about GP barriers and/or facilitators regarding ACP for people with dementia were included. We evaluated quality using the Mixed-Method-Appraisal-Tool and analyzed data using qualitative content analysis.ResultsTen qualitative, five quantitative, and one mixed-method paper revealed four themes: timely initiation of ACP, stakeholder engagement, important aspects of ACP the conversation, and prerequisites for ACP. Important barriers were: uncertainty about the timing of ACP, how to plan for an uncertain future, lack of knowledge about dementia, difficulties assessing people with dementia’s decisional capacities, and changing preferences. Facilitators for ACP were: an early start when cognitive decline is still mild, inclusion of all stakeholders, and discussing social and medical issues aimed at maintaining normal life.ConclusionDiscussing future care is difficult due to uncertainties about the future and the decisional capacities of people with dementia. Based on the facilitators, we recommend that GPs use a timely and goal-oriented approach and involve all stakeholders. ACP discussions should focus on the ability of people with dementia to maintain normal daily function as well as on their quality of life, instead of end-of-life-discussions only. GPs need training to acquire knowledge and skills to timely initiate collaborative ACP discussions.

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“…Clinicians should learn to communicate effectively scientific information, ensure patient understanding, and identify patient preferences [ 7 – 9 ]. For people with dementia and other frail patients, healthcare goals are more often directed toward improving wellbeing than toward cure or increased survival [ 10 – 12 ]. Clinicians should thus also learn to identify patient and caregiver priorities for managing functional status and the identification of healthcare goals and end-of-life preferences [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Tailoring and evaluating an intervention to improve shared decision-making among seniors with dementia, their caregivers, and healthcare providers: study protocol for a randomized controlled trial

Giguère

Lawani

Fortier-Brochu

et al. 2018

Trials

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BackgroundThe increasing prevalence of Alzheimer’s disease and other forms of dementia raises new challenges to ensure that healthcare decisions are informed by research evidence and reflect what is important for seniors and their caregivers. Therefore, we aim to evaluate a tailored intervention to help healthcare providers empower seniors and their caregivers in making health-related decisions.MethodsIn two phases, we will: (1) design and tailor the intervention; and (2) implement and evaluate it. We will use theory and user-centered design to tailor an intervention comprising a distance professional training program on shared decision-making and five shared decision-making tools dealing with difficult decisions often faced by seniors with dementia and their caregivers. Each tool will be designed in two versions, one for clinicians and one for patients. We will recruit 49 clinicians and 27 senior/caregiver to participate in three cycles of design-evaluation-feedback of each intervention components. Besides think-aloud and interview approaches, users will also complete questionnaires based on the Theory of Planned Behavior to identify the factors most likely to influence their adoption of shared decision-making after exposure to the intervention. We will then modify the intervention by adding/enhancing behavior-change techniques targeting these factors. We will evaluate the effectiveness of this tailored intervention before/after implementation, in a two-armed, clustered randomized trial. We will enroll a convenience sample of six primary care clinics (unit of randomization) in the province of Quebec and recruit the clinicians who practice there (mostly family physicians, nurses, and social workers). These clinics will then be randomized to immediate exposure to the intervention or delayed exposure. Overall, we will recruit 180 seniors with dementia, their caregivers, and their healthcare providers. We will evaluate the impact of the intervention on patient involvement in the decision-making process, decisional comfort, patient and caregiver personal empowerment in relation to their own healthcare, patient quality of life, caregiver burden, and decisional regret.DiscussionThe intervention will empower patients and their caregivers in their healthcare, by fostering their participation as partners during the decision-making process and by ensuring they make informed decisions congruent with their values and priorities.Trial registrationClinicalTrials.org, NCT02956694. Registered on 31 October 2016.Electronic supplementary materialThe online version of this article (10.1186/s13063-018-2697-1) contains supplementary material, which is available to authorized users.

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Shared decision making with frail older patients: Proposed teaching framework and practice recommendations

Cited by 43 publications

References 63 publications

Training surgeons in shared decision-making with cancer patients aged 65 years and older: a pilot study

Training surgeons in shared decision-making with cancer patients aged 65 years and older: a pilot study

Barriers and facilitators for GPs in dementia advance care planning: A systematic integrative review

Tailoring and evaluating an intervention to improve shared decision-making among seniors with dementia, their caregivers, and healthcare providers: study protocol for a randomized controlled trial

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