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Technology and health care for the elderly medical research studies

Focus on strategic priorities that have significant social impact.

CORE 2013-56

Improving the decision process about location of care with the frail elderly and their caregivers

Home care is a rapidly growing sector and this study will lay the foundations of a national strategy to ensure that no one has to be alone in making the difficult decision of whether to stay at home or move to a care facility.

Possible Research Results

Anticipated findingsThe frail elderly and caregivers from the trained group will have participated more in the decision making, and faced less uncertainty and regret than those from the control group.

Impact of findingsPositive findings may reduce the gap between patients, families and the health system and promote well-coordinated patient-centred care. It may also improve collaborative attitudes, knowledge and skills among healthcare professionals. Policy makers and healthcare educators will have the evidence they need to make interprofessional education and a patient-centred approach part of the health care curriculum. They may systematize a more collaborative approach to caring for the elderly. This approach to decision making will help the frail elderly and caregivers make informed decisions in keeping with their values and preferences. This in turn may reduce regret, guilt, ambivalence, dissatisfaction, conflict with family, poor health-related quality of life, and inappropriate use of healthcare services.

Publications, presentations and webinars

About the Project

One of the toughest decisions faced by the frail elderly in Canada is whether to stay at home or move to a care facility. Shared decision making is when, instead of making decisions for the patient, doctors share information about what the evidence says, and they talk about what’s important with the patient, and then make the decision together. In the case of the frail elderly in home care services, there are many health care workers involved, (e.g. doctors, nurses social workers). In this case, decisions should be shared by all the professionals involved with the elderly person along with his or her caregivers. Unfortunately, in this context, shared decision making rarely occurs.

We have designed a training program that teaches doctors and interprofessional teams how to share decisions with their frail elderly patients, and tested it in one Quebec City and one Edmonton home care team. This project tested the training program on a broader scale with 16 home care teams attached to community health centres across the province of Quebec, and compared the results with what happens when no one has completed the training. Home care is a rapidly growing sector and this study started to lay the foundations of a national strategy to ensure that no one has to make this difficult decision alone.

For more details on the project rationale, hypothesis, objectives and research plan, click here.

Project Team

Principal Investigator:

France Légaré, MD, PhD, CCFP, FCFP -- Université Laval

Dawn Stacey, PhD, RN -- University of Ottawa

Co-Investigators:

Sophie Desroches, PhD, RD -- Université Laval

Serge Dumont, PhD -- Université Laval

Pierre Durand, MD -- Université Laval

Kimberly Fraser, PhD, MA, BN, RN -- University of Alberta

Maman Joyce Dogba, MD, PhD -- Université Laval

Louis-Paul Rivest, PhD -- Université Laval

Knowledge Users and Partners:

Celine Allard -- Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale

Danielle Benoît -- Ministère de la Santé et des services sociaux du Québec

Henriette Bourassa -- Caregiver Representative

Nathalie Brière -- Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale

France Falardeau -- Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale

Josée Gauthier -- Consortium InterEst Santé

Sylvie Greco-LeMay -- Ministère de la Santé et des services sociaux du Québec

Lise Roy -- Association des proches aidants de la Capitale-Nationale

Tim Sutton -- Centre intégré de santé et de services sociaux (CISSS) de la Gaspésie

Project Contact: France Légaré -- france.legare@mfa.ulaval.ca

CORE 2013-56

Key words: shared decision making; patient centred care; frail elderly; interprofessionalism; home care; caregivers; location of care; decisional needs; decision support