Shared decision making and case management: construction

a decision support tool

principal investigators

Marie-Eve Poitras, France Légaré, Mathieu Bujold, Pierre Pluye, Sylvain Gagnon, Karina Prévost, Claude Spence, Annie Poirier

Funding

$ 121,000

Quebec Patient-Oriented Research Support Unit (SPOR)

study setting

Saguenay-Lac-Saint-Jean

Quebec

Monteregie

Montreal

themes

Case management, high users of care, decision points, 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 develop his autonomy in the management of his health. Participation in such a program  can  also reduce emergency room visits and hospitalizations.  

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What are our goals?

1) Identify the decision-making needs of high users of health services from the perspective of patients, des 

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

How?

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.

In order 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 these decision-making

  • Desired personal role in these decision-making for oneself and for significant 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

decisions relate to five themes:

  • Use of services and selection of a professional

  • health

  • 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 of

consider :

  • Limit the amount of information as much as possible

  • Use simple vocabulary and address directly

          au patient

  • 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 sectionKnowledge transfer or in the scientific article below.  We are currently preparing the implementation of 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 pageTool Kit for Nurses.

Publications

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

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Testimony

"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