Improve decision making involving frail elderly and caregivers on location of care

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One of the toughest decisions faced by the frail elderly in Canada is whether to stay at home or move to a care facility. It is certainly difficult to make this decision alone, but can be even harder if someone else makes it for you. 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. the doctor, nurse and social worker. 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.

Dr. France Légaré, MD, PhD, CCFP, FCFP practices family medicine, is a Professor in the Department of Family Medicine and Emergency Medicine at Université Laval, a clinical investigator at the CHUQ Research Centre, and is also the Canadian Cochrane Network Site representative at Université Laval and CHUQ Research Centre. In addition, she is a Tier 1 Canada Research Chair in shared decision making and knowledge translation. Dr. Légaré completed her PhD in Population Health at the University of Ottawa.  Her research interests include the implementation process of shared decision making in primary care, knowledge transfer, systematic literature reviews and decision support tools.