Intervention to Improve Shared Decision Making Among Seniors With Dementia, Their Caregivers and Healthcare Providers

NCT02956694 | Completed

• 1 other identifier: 2014-2015-PSVT2-31404
• Study Type: interventional
• Target: 47
• Locations: 1 country
• Sites: 1

Brief Summary

The increasing prevalence of Alzheimer's disease and other forms of dementia causes new challenges to ensure that healthcare decisions are informed by research evidence and reflect what is important for seniors and their caregivers. Primary care providers point to a need for more training on communication with families of seniors living with dementia, and on the non-pharmacological health options that are often recommended before use of medications.Therefore, the investigators will design and evaluate an intervention to train primary healthcare providers on how to empower seniors with dementia and their caregivers in making health-related decisions based on research evidence and on their preferences and priorities. A distance professional training program on shared decision making will initially be designed, comprising evidence summaries to be shared with patients living with dementia and their caregivers who face difficult decisions. Patients with dementia, their caregivers and healthcare providers, will then provide feedback on the training program, which will then be improved following their suggestions. In a last step, the investigators will study the processes required to implement this training program and measure its effects on provider knowledge and intention to adopt shared decision making.

Conditions

Dementia; Professional-Patient Relations; Professional-Family Relations; Aging

Keywords

Aged; Cognitive impairment; Neurocognitive Disorders; Shared decision making; Distance learning; Primary care; Decision support tool; Patient decision aid

Outcome Measures

Primary Outcomes (3)

• Change in healthcare providers' intention to adopt shared decision making

  Participants' intention to use shared decision making with their next patient facing a preference-sensitive decision, and the determinants of this intention (attitude, beliefs about capabilities, moral norm, and social influence), using a brief 5-item version of the CPD-REACTION (Légaré et al. Development of a Simple 12-Item Theory-Based Instrument to Assess the Impact of Continuing Professional Development on Clinical Behavioral Intentions. PLoS One. 2014; 9(3): e91013.

  Right before training, and then one week after the end of training

• Change in healthcare providers' knowledge

  This outcome comprises: knowledge about shared decision making, knowledge about risk communication, perceived awareness of the options. It also comprises variables to assess clinical knowledge on deprescribing anti-psychotics, on the impacts of stopping driving, on the strategies to communicate about stopping driving, on the risk factors for caregiver burden, on the awareness of the information to provide patients to reflect upon the power of attorney, on the elements to check prior to recommending a treatment to a vulnerable senior. Two questions were inspired by the Ottawa Decision Support Framework to assess participants' knowledge about SDM (https://decisionaid.ohri.ca/docs/develop/ODSF.pdf); and 10 questions included case-based scenarios,to assess clinical knowledge relative to the care of older adults living with NCD, and reflected the basic principles to develop constructed-response items \[28\].

  Right before training, and then one week after the end of training

• Change in Healthcare providers' role preference

  Healthcare professionals' preferred role in decision-making (Strull WM, Lo B, Charles G. Do patients want to participate in medical decision making? JAMA.

  Right before training, and then one week after the end of training

Study Arms (1)

Professional training

EXPERIMENTAL

Professional e-learning program on shared decision making including two components: (1) a self-directed e-learning activity on shared decision making, lasting about 1 hour, that participants could complete in several sittings; and (2) five evidence summaries named Decision Boxes (DBs).

Behavioral: Professional e-learning program on shared decision making

Interventions

Professional e-learning program on shared decision making BEHAVIORAL

Clinicians will have access to a, e-learning program on shared decision making (e-TUDE) during one month. They will also receive five Decision Boxes (DB) dealing with difficult decisions often faced by seniors with dementia and their caregivers in primary care. They will receive five DBs by email, at a rate of 1 per week for 5 weeks.

Professional training

Eligibility Criteria

• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Healthcare professionals from various professions (e.g., family physicians, nurses, and social workers) who practice in family medicine clinics and homecare services in the province of Quebec, Canada.

You may not qualify if:

• None.

Sponsors & Collaborators

• Anik Giguère: lead
• Ministère de l'Économie, de l'Innovation et de l'Exportation du Québec: collaborator
• SOVAR: collaborator
• Laval University: collaborator

Study Sites (1)

Réseau de Recherche Axée sur les Pratiques de Première Ligne Université Laval (RRAPPL-UL)

Québec, G1V 0A6, Canada

Location

Related Publications (1)

• Giguere AMC, Lawani MA, Fortier-Brochu E, Carmichael PH, Legare F, Kroger E, Witteman HO, Voyer P, Caron D, Rodriguez C. 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. Trials. 2018 Jun 25;19(1):332. doi: 10.1186/s13063-018-2697-1.

  PMID: 29941020 DERIVED

MeSH Terms

Conditions

Dementia; Cognitive Dysfunction; Neurocognitive Disorders

Condition Hierarchy (Ancestors)

Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Mental Disorders; Cognition Disorders

Study Officials

• Anik MC Giguere, PhD

  Laval University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: Assitant Professor

Model Details: We evaluated the effectiveness of the intervention, here a training program, using a pre-post design, and also assessed the barriers and facilitators to completing the training program.

Study Record Dates

• First Submitted: October 31, 2016
• First Posted: November 7, 2016
• Study Start: October 1, 2016
• Primary Completion: October 8, 2018
• Study Completion: October 8, 2018
• Last Updated: March 23, 2020

Record last verified: 2020-03

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP, ICF
• Time Frame: The data will be available after the study is published.
• Access Criteria: Contact the trial sponsor at anik.giguere@fmed.ulaval.ca

Locations

CA (1)