When We Face Multiple Decisions: A Dissemination Toolkit for Shared Decision-Making Focused on the Decision-Making Needs of Patients with Complex Care Needs and High Service Users

principal investigators

Marie-Eve Poitras,

Maud-Christine Chouinard, Pierre Pluye, Mathieu Bujold, Catherine Hudon,

France Légaré, Annie Poirier, Karina Prévost, Claude Spence

Funding

$ 20,000

Quebec Nursing Intervention Research Network (RRISIQ)

study setting

Nursing Department of the CI (U) SSS of the Province of Quebec

themes

Shared decision-making, high users of care, decision-making needs

Why?

Thanks to the work carried out by our research team, we have found that the decision-making needs and the burden associated with multiple decision-making of patients with complex care needs are unrecognized by clinicians. In clinical settings, nurses are particularly involved with these patients in the context of monitoring chronic physical or mental illnesses in collaboration with the family doctor or social workers from the family medicine group (GMF).

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What are our goals?

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The aim of this project is to support the acquisition of knowledge of nurses in FMG to support patients with complex care needs and high users of services in the process of shared decision-making. In the short term, the overall aim of the project is to inform and educate nurses about the reality of patients living with a complex health condition and often attending health services. The health condition of these patients entails for them a multitude of daily decision points that they must consider. Thanks to this project, we hope:

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1) Improve the knowledge of nurses in FMG in the face of patients with a complex health condition;

2) Better define their role and the role of the patient in shared decision-making;

3) Provide FMG nurses with avenues and tools to facilitate decision-making using a shared decision-making approach.

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How? 'Or' What?

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The project is divided into two phases. Phase 1 will allow the creation of the dissemination kit and phase 2, the evaluation of its dissemination on the acquisition of knowledge of nurses and nursing directors.

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Phase 1: Content of the dissemination kit

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In order to achieve our objectives, we propose to create a dissemination kit that will be given to the 22 nursing directors in the province. Concretely, the kit will contain:

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1) Video capsules showing the daily reality of patients and the issues related to their care trajectory and the multiple decisions to be made;

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2) A PowerPoint presentation that can be broadcast on televisions in FMGs, emergencies and CLSCs;

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3) Andragogical content in the form of a narrated PowerPoint presentation to present key messages and evidence. This series of slides will show nurses how to prioritize decision-making needs within a shared decision-making process between nurse and patient;

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4) A series of bookmarks and large posters with key messages that can be placed in waiting rooms of primary care facilities and clinicians' offices.

Phase 2: Assessment of the dissemination and dissemination strategy

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A descriptive quantitative study will be carried out. We will evaluate the success of our knowledge transfer through different parameters such as scope, utility as well as use.

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What results do we hope to achieve?

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Thanks to this project, nurses working in FMGs will have access to training presenting them with unique and innovative research results for patients of FMGs. In particular, at the end of this project, they will have acquired knowledge enabling them to improve their feeling of competence in supporting patients with complex needs. They will also be more comfortable with:

1) Identify the decisions these patients need to make

2) Help them identify their values

3) Identify the sources of relevant scientific literature that can help the patient to make a decision

4) Validate the person-centered decision-making process

We believe that this project will allow FMG nurses to approach the care of patients who are heavy users and have complex needs in a different way. The care offered to patients will be improved and will promote better management. Another expected impact is the sensitization of managers and care departments. The contents of the kit will help them understand the reality of these patients in their strategic and organizational decision-making. In addition, this project will generate several direct benefits for the clinical environment. First of all, the content of the dissemination kit will remain available and can be used in contexts other than that of the project. There are many people with complex care needs who are heavy users of services and can be found in all health establishments. This content is therefore of transversal relevance.

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