Top

BMC Medical Informatics and Decision Making

Published in:

01-12-2020 | Care | Research article

Professional training on shared decision making with older adults living with neurocognitive disorders: a mixed-methods implementation study

Authors: Moulikatou Adouni Lawani, Luc Côté, Laetitia Coudert, Michèle Morin, Holly O. Witteman, Danielle Caron, Edeltraut Kroger, Philippe Voyer, Charo Rodriguez, France Légaré, Anik M. C. Giguere

Published in: BMC Medical Informatics and Decision Making | Issue 1/2020

Abstract

Background

Shared decision making with older adults living with neurocognitive disorders is challenging for primary healthcare professionals. We studied the implementation of a professional training program featuring an e-learning activity on shared decision making and five Decision Boxes on the care of people with neurocognitive disorders, and measured the program’s effects.

Methods

In this mixed-methods study, we recruited healthcare professionals in family medicine clinics and homecare settings in the Quebec City area (Canada). The professionals signed up for training as a continuing professional development activity and answered an online survey before and after training to assess their knowledge, and intention to adopt shared decision making. We recorded healthcare professionals’ access to each training component, and conducted telephone interviews with a purposeful sample of extreme cases: half had completed training and the other half had not. We performed bivariate analyses with the survey data and a thematic qualitative analysis of the interviews, as per the theory of planned behaviour.

Results

Of the 47 participating healthcare professionals, 31 (66%) completed at least one training component. Several factors restricted participation, including lack of time, training fragmentation into several components, poor adaptation of training to specific professions, and technical/logistical barriers. Ease of access, ease of use, the usefulness of training content and the availability of training credits fostered participation. Training allowed Healthcare professionals to improve their knowledge about risk communication (p = 0.02), and their awareness of the options (P = 0.011). Professionals’ intention to adopt shared decision making was high before training (mean ± SD = 5.88 ± 0.99, scale from 1 to 7, with 7 high) and remained high thereafter (5.94 ± 0.9).

Conclusions

The results of this study will allow modifying the training program to improve participation rates and, ultimately, uptake of meaningful shared decision making with patients living with neurocognitive disorders.

Stacey D, Legare F, Lewis K, Barry MJ, Bennett CL, Eden KB, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2017;4:CD001431 https://doi.org/10.1002/14651858.CD001431.pub5.PubMed

Couet N, Desroches S, Robitaille H, Vaillancourt H, Leblanc A, Turcotte S, et al. Assessments of the extent to which health-care providers involve patients in decision making: a systematic review of studies using the OPTION instrument. Health Expect. 2015;18:542–61.PubMedCrossRef

Hanson LC, Zimmerman S, Song M-KK, Lin F-CC, Rosemond C, Carey TS, et al. Effect of the goals of care intervention for advanced dementia: a randomized clinical trial. JAMA Intern Med. 2017;177:24–31 https://doi.org/10.1001/jamainternmed.2016.7031.PubMedPubMedCentralCrossRef

Einterz SF, Gilliam R, Lin FC, McBride JM, Hanson LC. Development and testing of a decision aid on goals of care for advanced dementia. J Am Med Dir Assoc. 2014;15:251–5 https://doi.org/10.1016/j.jamda.2013.11.020.PubMedPubMedCentralCrossRef

Adekpedjou R, Stacey D, Briere N, Freitas A, Garvelink MM, Dogba MJ, et al. Engaging Caregivers in Health-Related Housing Decisions for Older Adults With Cognitive Impairment: A Cluster Randomized Trial. Gerontologist. 2019;60(5):947–57 https://academic.oup.com/gerontologist/article/60/5/947/5490227.PubMedCentralCrossRef

Adekpedjou R, Stacey D, Brière N, Freitas A, Garvelink MM, Turcotte S, et al. “Please listen to me”: a cross-sectional study of experiences of seniors and their caregivers making housing decisions. PLoS One. 2018;13:1–19.CrossRef

Miller LM, Whitlatch CJ, Lyons KS. Shared decision-making in dementia: a review of patient and family carer involvement. Dement. 2016;15:1141–57.CrossRef

Légaré F, Adekpedjou R, Stacey D, Turcotte S, Kryworuchko J, Graham ID, et al. Interventions for increasing the use of shared decision making by healthcare professionals. Cochrane Database Syst Rev. 2018;7:CD006732 https://doi.org/10.1002/14651858.CD006732.pub4.PubMed

Diouf NT, Menear M, Robitaille H, Painchaud Guérard G, Légaré F. Training health professionals in shared decision making: update of an international environmental scan. Patient Educ Couns. 2016;99:1753–8.PubMedCrossRef

10.

Siyam T, Shahid A, Perram M, Zuna I, Haque F, Herrera MCA, et al. A scoping review of interventions to promote the adoption of shared decision-making (SDM) among health care professionals in clinical practice. Patient Educ Couns. 2019;102:1057–66.PubMedCrossRef

11.

Shahhosseini Z, Hamzehgardeshi Z. The facilitators and barriers to nurses’ participation in continuing education programs: a mixed method explanatory sequential study. Global J Health Sci. 2014;7:184–93 https://doi.org/10.5539/gjhs.v7n3p184.CrossRef

12.

Allaire AS, Labrecque M, Giguere A, Gagnon MP, Legare F. What motivates family physicians to participate in training programs in shared decision making? J Contin Educ Heal Prof. 2012;32:98–107 https://doi.org/10.1002/chp.21132.CrossRef

13.

Vaona A, Banzi R, Kwag KH, Rigon G, Cereda D, Pecoraro V, et al. E-learning for health professionals. Cochrane Database Syst Rev. 2018; https://doi.org/10.1002/14651858.CD011736.pub2.

14.

Legare F, Labrecque M, Cauchon M, Castel J, Turcotte S, Grimshaw J. Training family physicians in shared decision-making to reduce the overuse of antibiotics in acute respiratory infections: a cluster randomized trial. Cmaj. 2012;184:E726–34 https://doi.org/10.1503/cmaj.120568.PubMedPubMedCentralCrossRef

15.

Poirier A, Voyer P, Légaré F, Morin M, Witteman HO, Kröger E, et al. Caring for seniors living with dementia means caring for their caregivers too. Can J Public Heal. 2018;108:639 https://doi.org/10.17269/cjph.108.6217.CrossRef

16.

Giguere AMC, Labrecque M, Haynes RB, Grad R, Pluye P, Legare F, et al. Evidence summaries (decision boxes) to prepare clinicians for shared decision-making with patients: a mixed methods implementation study. Implement Sci. 2014;9:144.PubMedPubMedCentralCrossRef

17.

Giguere A, Legare F, Grad R, Pluye P, Haynes RB, Cauchon M, et al. Decision boxes for clinicians to support evidence-based practice and shared decision making: the user experience. Implement Sci. 2012;7:72 https://doi.org/10.1186/1748-5908-7-72.PubMedPubMedCentralCrossRef

18.

Bilodeau G, Witteman HO, Légaré F, Lafontaine-Bruneau J, Voyer P, Kröger E, et al. Reducing complexity of patient decision aids for community-based older adults with dementia and their caregivers: multiple case study of decision boxes. BMJ Open. 2019;9:e027727.PubMedPubMedCentralCrossRef

19.

Giguere AMC, Lawani MA, Fortier-Brochu É, Carmichael P-H, Légaré F, Kröger E, et al. 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;19:332 https://doi.org/10.1186/s13063-018-2697-1.PubMedPubMedCentralCrossRef

20.

Stacey D, Légaré F, Boland L, Lewis KB, Loiselle M-C, Hoefel L, et al. 20th anniversary Ottawa decision support framework: part 3 overview of systematic reviews and updated framework. Med Decis Mak. 2020;40:379–98.CrossRef

21.

Légaré F, Borduas F, Freitas A, Jacques A, Godin G, Luconi F, 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:e91013 https://doi.org/10.1371/journal.pone.0091013.PubMedPubMedCentralCrossRef

22.

Giguere AM, Bogza L-M, Coudert L, Carmichael P-H, Renaud J-S, Légaré F, et al. Development of the IcanSDM scale to assess primary care clinicians’ ability to adopt shared decision making. Res Sq. 2020; https://doi.org/10.21203/rs.3.rs-19647/v1.

23.

Strull WM, Lo B, Charles G. Do patients want to participate in medical decision making? JAMA. 1984;252:2990–4 https://www.ncbi.nlm.nih.gov/pubmed/6502860.PubMedCrossRef

24.

Lawani MA, Turgeon Y, Côté L, Légaré F, Witteman HO, Morin M, et al. User-centered and theory-based design of a professional training program on shared decision making with older adults living with neurocognitive disorders: a mixed-methods study. Submitt BMC Med Inf Decis Mak.

25.

Godin G, Belanger-Gravel A, Eccles M, Grimshaw J. Healthcare professionals’ intentions and behaviours: a systematic review of studies based on social cognitive theories. Implement Sci. 2008;3:36 https://doi.org/10.1186/1748-5908-3-36.PubMedPubMedCentralCrossRef

26.

Creswell JW. Research design: Qualitative, quantitative, and mixed methods approaches. 4th ed. Thousand Oaks: Sage; 2014.

27.

Vasileiou K, Barnett J, Thorpe S, Young T. Characterising and justifying sample size sufficiency in interview-based studies: systematic analysis of qualitative health research over a 15-year period. BMC Med Res Methodol. 2018;18:148.PubMedPubMedCentralCrossRef

28.

Cook DA, Price DW, Wittich CM, West CP, Blachman MJ. Factors influencing physicians’ selection of continuous professional development activities: a cross-specialty National Survey. J Contin Educ Heal Prof. 2017;37:154–60 https://doi.org/10.1097/CEH.0000000000000163.CrossRef

29.

Rosenstiel T, Mitchell A. YouTube & News: A new kind of visual journalism. Washington (DC): Pew Research Center; 2012. https://www.pewresearch.org/wp-content/uploads/sites/8/2012/07/YouTube-the-News-A-PEJ-Report-FINAL.pdf.

30.

Carr S. As distance education comes of age, the challenge is keeping the students. Chron High Educ. 2000;46(23):A39–41.

31.

Patterson B, McFadden C. Attrition in online and campus degree programs. Online J Distance Learn Adm. 2009;12:1–8.

32.

Jeong D, Presseau J, ElChamaa R, Naumann DN, Mascaro C, Luconi F, et al. Barriers and facilitators to self-directed learning in continuing professional development for physicians in Canada: a scoping review. Acad Med. 2018;93:1245–54 https://doi.org/10.1097/ACM.0000000000002237.PubMedPubMedCentralCrossRef

33.

Regmi K, Jones L. A systematic review of the factors–enablers and barriers–affecting e-learning in health sciences education. BMC Med Educ. 2020;20:1–18.CrossRef

34.

Ellaway R, Masters K. AMEE Guide 32: e-Learning in medical education Part 1: Learning, teaching and assessment. Med Teach. 2008;30:455–73. https://doi.org/10.1080/01421590802108331.PubMedCrossRef

35.

Broadbent J, Poon WL. Self-regulated learning strategies & academic achievement in online higher education learning environments: A systematic review. Internet High Educ. 2015;27:1–13.CrossRef

36.

Wang C, Hsu H-CK, Bonem EM, Moss JD, Yu S, Nelson DB, et al. Need satisfaction and need dissatisfaction: A comparative study of online and faceto-face learning contexts. Comput Hum Behav. 2019;95:114–25.CrossRef

37.

Kienlin S, Kristiansen M, Ofstad E, Liethmann K, Geiger F, Joranger P, et al. Validation of the Norwegian version of MAPPIN’SDM, an observationbased instrument to measure shared decision-making in clinical encounters. Patient Educ Couns. 2017;100:534–41. https://doi.org/10.1016/j.pec.2016.10.023.PubMedCrossRef

38.

Kasper J, Liethmann K, Heesen C, Reissmann DR, Geiger F. Training doctors briefly and in situ to involve their patients in making medical decisions—Preliminary testing of a newly developed module. Health Expect. 2017;20:1254–63. https://doi.org/10.1111/hex.12565.PubMedPubMedCentralCrossRef

39.

Mamary E, Charles P. Promoting self-directed learning for continuing medical education. Med Teach. 2003;25:188–90 https://acces.bibl.ulaval.ca/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=12745529&lang=fr&site=ehost-live.PubMedCrossRef

40.

Gagnon MP, Legare F, Labrecque M, Fremont P, Cauchon M, Desmartis M. Perceived barriers to completing an e-learning program on evidence-based medicine. Inf Prim Care. 2007;15:83–91 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=17877870.

41.

Smith L, Curry M. Twelve tips for supporting online distance learners on medical post-registration courses. Med Teach. 2005;27:396–400.PubMedCrossRef

42.

Giguere AMC, Labrecque M, Légaré F, Grad R, Cauchon M, Greenway M, et al. Feasibility of a randomized controlled trial to evaluate the impact of decision boxes on shared decision-making processes. BMC Med Inform Decis Mak. 2015;15.

43.

Giustini D, Ali SM, Fraser M, Boulos MNK. Effective uses of social media in public health and medicine: a systematic review of systematic reviews. Online J Public Health Inform. 2018;10.

44.

Hellström I, Nolan M, Nordenfelt L, Lundh U. Ethical and methodological issues in interviewing persons with dementia. Nurs Ethics. 2007;14:608–19.PubMedCrossRef

45.

Banzi R, Camaioni P, Tettamanti M, Bertele V, Lucca U. Older patients are still under-represented in clinical trials of Alzheimer’s disease. Alzheimers Res Ther. 2016;8:32. https://doi.org/10.1186/s13195-016-0201-2.PubMedPubMedCentralCrossRef

46.

Bartlett R, Milne R, Croucher R. Strategies to improve recruitment of people with dementia to research studies. Dementia. 2018;18:2494–504. https://doi.org/10.1177/1471301217748503.PubMedCrossRef

Title: Professional training on shared decision making with older adults living with neurocognitive disorders: a mixed-methods implementation study
Authors: Moulikatou Adouni Lawani
Luc Côté
Laetitia Coudert
Michèle Morin
Holly O. Witteman
Danielle Caron
Edeltraut Kroger
Philippe Voyer
Charo Rodriguez
France Légaré
Anik M. C. Giguere
Publication date: 01-12-2020
Publisher: BioMed Central
Keyword: Care
Published in: BMC Medical Informatics and Decision Making / Issue 1/2020
Electronic ISSN: 1472-6947
DOI: https://doi.org/10.1186/s12911-020-01197-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Professional training on shared decision making with older adults living with neurocognitive disorders: a mixed-methods implementation study

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2020

A qualitative study of physician perspectives on adaptation to electronic health records

Investigating usability of mobile health applications in Bangladesh

A stacking-based model for predicting 30-day all-cause hospital readmissions of patients with acute myocardial infarction

Towards a comprehensive and interoperable representation of consent-based data usage permissions in the German medical informatics initiative

As if sand were stone. New concepts and metrics to probe the ground on which to build trustable AI

Exploring emerging IoT technologies in smart health research: a knowledge graph analysis