Strategies to facilitate shared decision‐making in long‐term care

Abstract

Aim The aim of this study was to explore shared decision‐making among residents, their families and staff to determine relevant strategies to support shared decision‐making in long‐term care (LTC). Background Meaningful engagement of long‐term care home (LTCH) residents and their families in care decisions is key in the provision of quality of care. Shared decision‐making is an interprofessional approach to increasing resident and family engagement in care decisions which can lead to higher quality decisions, more relevant care interventions and greater resident, family, and staff satisfaction. Despite these advantages, shared decision‐making has not been widely implemented in practice in LTC. Methods The study took place in one LTCH in Toronto, Ontario, Canada. A qualitative descriptive design was used to explore how residents, family members and staff described how they collaborate when making decisions concerning resident care, and their perceptions of facilitators and challenges to a collaborative approach to decision‐making. Individual interviews were conducted with nine participants: residents, families and staff. Data were analysed using content and thematic analysis. Findings Four main themes that described resident, family and staff perspectives of shared decision‐making were as follows: (a) oral communication pathways for information sharing; (b) supporting resident decision‐making autonomy; (c) relational aspects of care facilitate shared decision‐making; and (d) lack of effective communication creates barriers to shared decision‐making. Conclusion As the demand for LTC continues to increase, it is crucial that healthcare providers engage in collaborative, relational practices that foster high‐quality resident care. While a relational approach to care can facilitate shared decision‐making, there are opportunities to further cultivate shared decision‐making in LTCHs through more effective communication and collaboration. Implications for practice Understanding how information is shared and decisions are made can facilitate shared decision‐making in LTCHs. The strategies identified from this study could be further co‐developed and implemented in LTCHs.

Relational autonomy in end-of-life care ethics: a contextualized approach to real-life complexities

“…In addition, empirical studies show that while some patients wish to have full control in the deliberative process, others prefer to defer decision-making to their family members or, at least, to consider their interests extensively [39,40]. In end-oflife care, healthcare staff and family are often intimately involved, all being individuals that may affect, and be affected by, the patient's autonomous decisions [21,41,42].…”

“…Thus, a scalar notion of autonomy, more context-sensitive, implies that doctors' responsibility to provide the best treatment takes different forms depending on whether the patient is completely autonomous or is autonomous to a lesser degree. Along these lines, Killackey and colleagues maintain that "a relational view of autonomy allows a broader account of personhood that recognizes the subtleties of autonomy and includes a range of capacities, which can still be expressed within and through relationships of vulnerability and dependence" [21].…”

“…In this regard, a relational account of autonomy has been advocated as a more suitable approach [16,17]. In end-of-life care, relational autonomy has been proposed to be a foundational notion of palliative care [18,19], shared decision making [20,21], and advance care planning [22,23].…”

Consistent assignment in long‐term care homes: Avoiding the pitfalls to capitalise on the promises

“…Family members felt CA engendered relationships that supported their efforts to be part of the care team. This is significant because enabling family members to be active members of the care team and increasing their engagement in care decisions is a central tenet of PCC and is associated with quality of care and improved health (Carman et al., 2013; Cranley et al., 2020).…”

Meaningful Engagement of Older Adults in Long-Term Care: A Call for Action

“…Such innovative approaches could result in more relevant strategies that meet residents' needs. For example, co-designed strategies could include shared approaches to decision-making through more effective communication and collaboration (Cranley et al, 2020). While many residents in LTC homes have some form of cognitive impairment (Canadian Institute for Health Information [CIHI],2018[CIHI], -2019, such impairment should not preclude their involvement in care activities or research (Holroyd-Leduc et al, 2016).…”