Shared Decision Making And Case management: construction of a tool to aid decision
Marie-Eve Poitras, France Légaré, Mathieu Bujold, Pierre Pluye, Sylvain Gagnon, Karina Prévost, Claude Spence, Annie Poirier
Quebec Patient-Oriented Research Support Unit (SPOR)
Case management, high users of care, decision points, decision support tool
Some people living with multiple chronic physical and mental illnesses require complex health care. These patients have to make several decisions every day regarding their health. They can sometimes be heavy users of services and some benefit from a case management program. Case management is a type of follow-up carried out by a multidisciplinary team (nurse, social worker, physiotherapist, nutritionist, etc.) that can help the patient develop his autonomy in the management of his health. Participation in such a program can also reduce emergency room visits and hospitalizations.
What are our goals?
1) Identify the decision-making needs of high users of health services from the perspective of patients, caregivers, health professionals and decision-makers
2) Develop a decision support tool that facilitates shared decision-making for this clientele
3) Define a tool implementation strategy
Our project is based on the Decision Support Model of Ottawa (MADO), the User Experience Model (Honeycomb), Shared Decision Making and the International Patient Decision Aids Standards.
To identify the needs of large service users, we used:
1) Individual interviews with heavy users and family caregivers, case managers, decision-makers
2) Group interviews with health and social services professionals
3) Questionnaires of socio-demographic data for high-user patients and professionals
4) Decision support tool evaluation questionnaires
Then, we proceeded to the codification of the interviews according to the following themes:
Most common decisions faced by stakeholders
Decisions deemed most difficult or most important
Factors that make these decisions difficult
Factors that have the potential to facilitate these decisions
Sources of information used
Significant people in this decision-making
Desired personal role in this decision-making for oneself and influential people
Strategies for the dissemination of an integrated program to support interprofessional shared decision-making with patients who are high users of services
Preferred format and content for the decision support tool
What results have we had?
We have identified 26 types of decisions that must be
take care-intensive patients. These
findings relate to five themes:
Use of services and selection of a healthcare professional
Management of the patient environment
(physical and social)
Level of care and end of life
Health Condition Management
Acceptance of health condition
The evaluation of the appreciation of the decision
support tool has allowed to shed light on the essential
elements to consider:
Limit the amount of information as much as possible
Use simple vocabulary and address directly
Facilitate the use of the tool by clinicians
Have an attractive visual
Include fictional or real patient stories
Our decision support tool is available in the Knowledge
Transfer section or the scientific article below. We are
preparing to implement this decision support tool in two
hospitals in the Saguenay-Lac-Saint-Jean region.
This project inspired us to create an information kit for nurses working in family medicine groups. To learn more, visit the page tool Kit for Nurses.
Poitras, ME., Légaré, F., Tremblay Vaillancourt, V. et al. High Users of Healthcare Services: Development and Alpha Testing of a Patient Decision Aid for Case Management. Patient 13, 757–766 (2020).https://doi.org/10.1007/s40271-020-00465-0
Poitras, M‐E, Hudon, C, Godbout, I, et al. Decisional needs assessment of patients with complex care needs in primary care. J Eval Clin Pract. 2020; 26: 489–502. https://doi.org/10.1111/jep.13325
"Should my patient move to a retirement home? It's not easy to make the decision when you've lived in your home for 50 years."
Marc, Case Manager