Using Shared Decision-Making Resources in Long-Term Care: a Qualitative Study

Wade Thompson; Lisa M. McCarthy; Emily Galley; Loreena Homan; Barbara Farrell

doi:10.5770/cgj.26.657

Using Shared Decision-Making Resources in Long-Term Care: a Qualitative Study

Wade Thompson^*, Lisa M. McCarthy, Emily Galley, Loreena Homan, Barbara Farrell

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Abstract

Background Shared decision-making (SDM) incorporates people’s individual preferences and context into individualized, person-centred decisions. Persons living in long-term care (LTC) should only take medications that are a good fit for them as individuals.

Methods We conducted a pilot study to understand experiences of two LTC homes in Ontario as they tested implementing SDM resources to support medication decisions. LTC homes conducted two Plan-Do-Study-Act (PDSA) cycles supported by an Advisory Group composed of LTC home representatives and stakeholders involved in resource design. Rapid qualitative analysis of transcripts and field notes from Advisory Group meetings elucidated how SDM resources were used.

Results Each site was positively engaged but implemented resources differently. The pharmacist and physicians at Site 1 introduced proton-pump inhibitor (PPI) deprescribing as their primary intervention, identifying suitable residents, informing residents and families of the deprescribing process, and providing selected SDM resources to residents, caregivers and staff. Representatives reported limited engagement with SDM resources and difficulty measuring the impact of PPI deprescribing. Representatives from Site 2 disseminated the SDM resources to residents and caregivers for use at care conferences and focused on front-line staff education and involvement. This site reported that some residents/caregivers were interested in participating in SDM and using the resources, while others were not. The impact of the resources on SDM at this site was unclear.

Conclusions Within the context of LTC, further research is needed to clarify the meaning and importance of SDM in medication decision-making. Implementation of SDM will likely require a multi-faceted approach.

Originalsprog	Engelsk
Tidsskrift	Canadian Geriatrics Journal
Vol/bind	26
Udgave nummer	2
Sider (fra-til)	253-258
ISSN	1925-8348
DOI	https://doi.org/10.5770/cgj.26.657
Status	Udgivet - 1. jun. 2023

Bibliografisk note

Funding Information:
This publication is supported in part with funding from the Government of Ontario through the Ontario Centres for Learning, Research and Innovation in Long-Term Care hosted at Bruyère. The views expressed herein do not necessarily reflect the views of the province.

Publisher Copyright:
© 2023 Author(s).

Dokumenter og links

10.5770/cgj.26.657Licens: CC BY-NC-ND

Open Access VersionForlagets udgivne version, 430 KBLicens: CC BY-NC-ND

Citationsformater

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abstract = "Background Shared decision-making (SDM) incorporates people{\textquoteright}s individual preferences and context into individualized, person-centred decisions. Persons living in long-term care (LTC) should only take medications that are a good fit for them as individuals. Methods We conducted a pilot study to understand experiences of two LTC homes in Ontario as they tested implementing SDM resources to support medication decisions. LTC homes conducted two Plan-Do-Study-Act (PDSA) cycles supported by an Advisory Group composed of LTC home representatives and stakeholders involved in resource design. Rapid qualitative analysis of transcripts and field notes from Advisory Group meetings elucidated how SDM resources were used. Results Each site was positively engaged but implemented resources differently. The pharmacist and physicians at Site 1 introduced proton-pump inhibitor (PPI) deprescribing as their primary intervention, identifying suitable residents, informing residents and families of the deprescribing process, and providing selected SDM resources to residents, caregivers and staff. Representatives reported limited engagement with SDM resources and difficulty measuring the impact of PPI deprescribing. Representatives from Site 2 disseminated the SDM resources to residents and caregivers for use at care conferences and focused on front-line staff education and involvement. This site reported that some residents/caregivers were interested in participating in SDM and using the resources, while others were not. The impact of the resources on SDM at this site was unclear. Conclusions Within the context of LTC, further research is needed to clarify the meaning and importance of SDM in medication decision-making. Implementation of SDM will likely require a multi-faceted approach.",

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author = "Wade Thompson and McCarthy, {Lisa M.} and Emily Galley and Loreena Homan and Barbara Farrell",

note = "Funding Information: This publication is supported in part with funding from the Government of Ontario through the Ontario Centres for Learning, Research and Innovation in Long-Term Care hosted at Bruy{\`e}re. The views expressed herein do not necessarily reflect the views of the province. Publisher Copyright: {\textcopyright} 2023 Author(s).",

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doi = "10.5770/cgj.26.657",

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AU - Homan, Loreena

AU - Farrell, Barbara

N1 - Funding Information: This publication is supported in part with funding from the Government of Ontario through the Ontario Centres for Learning, Research and Innovation in Long-Term Care hosted at Bruyère. The views expressed herein do not necessarily reflect the views of the province. Publisher Copyright: © 2023 Author(s).

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N2 - Background Shared decision-making (SDM) incorporates people’s individual preferences and context into individualized, person-centred decisions. Persons living in long-term care (LTC) should only take medications that are a good fit for them as individuals. Methods We conducted a pilot study to understand experiences of two LTC homes in Ontario as they tested implementing SDM resources to support medication decisions. LTC homes conducted two Plan-Do-Study-Act (PDSA) cycles supported by an Advisory Group composed of LTC home representatives and stakeholders involved in resource design. Rapid qualitative analysis of transcripts and field notes from Advisory Group meetings elucidated how SDM resources were used. Results Each site was positively engaged but implemented resources differently. The pharmacist and physicians at Site 1 introduced proton-pump inhibitor (PPI) deprescribing as their primary intervention, identifying suitable residents, informing residents and families of the deprescribing process, and providing selected SDM resources to residents, caregivers and staff. Representatives reported limited engagement with SDM resources and difficulty measuring the impact of PPI deprescribing. Representatives from Site 2 disseminated the SDM resources to residents and caregivers for use at care conferences and focused on front-line staff education and involvement. This site reported that some residents/caregivers were interested in participating in SDM and using the resources, while others were not. The impact of the resources on SDM at this site was unclear. Conclusions Within the context of LTC, further research is needed to clarify the meaning and importance of SDM in medication decision-making. Implementation of SDM will likely require a multi-faceted approach.

AB - Background Shared decision-making (SDM) incorporates people’s individual preferences and context into individualized, person-centred decisions. Persons living in long-term care (LTC) should only take medications that are a good fit for them as individuals. Methods We conducted a pilot study to understand experiences of two LTC homes in Ontario as they tested implementing SDM resources to support medication decisions. LTC homes conducted two Plan-Do-Study-Act (PDSA) cycles supported by an Advisory Group composed of LTC home representatives and stakeholders involved in resource design. Rapid qualitative analysis of transcripts and field notes from Advisory Group meetings elucidated how SDM resources were used. Results Each site was positively engaged but implemented resources differently. The pharmacist and physicians at Site 1 introduced proton-pump inhibitor (PPI) deprescribing as their primary intervention, identifying suitable residents, informing residents and families of the deprescribing process, and providing selected SDM resources to residents, caregivers and staff. Representatives reported limited engagement with SDM resources and difficulty measuring the impact of PPI deprescribing. Representatives from Site 2 disseminated the SDM resources to residents and caregivers for use at care conferences and focused on front-line staff education and involvement. This site reported that some residents/caregivers were interested in participating in SDM and using the resources, while others were not. The impact of the resources on SDM at this site was unclear. Conclusions Within the context of LTC, further research is needed to clarify the meaning and importance of SDM in medication decision-making. Implementation of SDM will likely require a multi-faceted approach.

KW - deprescribing

KW - medication management

KW - older adults

KW - resource implementation

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DO - 10.5770/cgj.26.657

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SN - 1925-8348

VL - 26

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EP - 258

JO - Canadian Geriatrics Journal

JF - Canadian Geriatrics Journal

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ER -

Using Shared Decision-Making Resources in Long-Term Care: a Qualitative Study

Abstract

Bibliografisk note

Dokumenter og links

Fingeraftryk

Citationsformater