Shared decision making and case management: construction

a decision support tool

Why?

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 to develop his autonomy in the management of his health. Participation in such a program can also decrease emergency room visits and hospitalizations.

What are our goals?

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1) Identify the decision-making needs of major 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 strategy for implementing the tool

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How? 'Or' What?

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Our project is based on the Ottawa Decision Support Model (MADO), the User Experience Model (Honeycomb), shared decision making and the International Patient Decision Aids Standards.

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In order to identify the needs of large service users, we used:

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1) Individual interviews with high user patients and caregivers, case managers, decision makers

2) Group interviews with health and social services professionals

3) Sociodemographic data questionnaires for patients who are heavy users and professionals

4) Assessment questionnaires for the decision support tool

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We then proceeded to codify the interviews according to the following themes:

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• Most frequent decisions faced by stakeholders

• Decisions considered to be the most difficult or the most important

• Factors that make these decisions difficult

• Factors that have the potential to facilitate these decisions

• Sources of information used

• Significant people in these decision-making

• Personal role desired in making decisions for oneself and for significant people

• Dissemination strategies for an integrated program to support shared interprofessional decision-making with patients who are high users of services

• Preferred format and content for the decision support tool

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What results have we had?

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We have identified 26 types of decisions that must be

taken by patients who are heavy users of care. These

decisions cover five themes:

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• Use of services and selection of a  health professional

• Patient environment management

• (physical and social)

• Level of care and end of life

• Health condition management

• Acceptance of the health condition

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The assessment of the appreciation of the decision support tool was

allowed to highlight the essential elements

consider :

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• Limit the amount of information as much as possible

• Use simple vocabulary and speak directly to the patient

• Facilitate the use of the tool by clinicians

• Have an attractive visual

• Include stories from fictitious or real patients

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Our decision support tool is available in the Knowledge transfer section or in the scientific article below. The implementation   of this decision support tool in two hospitals in the Saguenay-Lac-Saint-Jean region is currently underway.

This project inspired us to create an information kit for nurses working in family medicine groups. To learn more, visit the Nursing Toolkit page.

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Publications

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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

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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

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