Légaré France, Stacey Dawn, Brière Nathalie, Robitaille Hubert, Lord Marie-Claude, Desroches Sophie, Drolet Renée
Research Centre of the Centre Hospitalier Universitaire de Québec, Hôpital Saint-François d'Assise, 10 de L'Espinay, Room D6-735, Quebec City G1L 3 L5, Canada.
BMC Geriatr. 2014 Jul 2;14:83. doi: 10.1186/1471-2318-14-83.
Within the context of an exploratory case study, the authors assessed the perceptions of family caregivers about the decision-making process regarding relocating their relative and about the applicability of an interprofessional approach to shared decision making (IP-SDM). They also assessed perceptions of health professionals and health managers about IP-SDM.
From November 2010 to October 2011, we worked with one IP home care team dedicated to older adults (the case) from a large primary health care organization in Quebec City, Canada. We identified six of their clients who had faced a decision about whether to stay at home or move to a long-term care facility in the past year and interviewed their family caregivers. We explored the decision-making process they had experienced regarding relocating their relative and their perceptions about the applicability of IP-SDM in this context. Attitudes towards IP-SDM and potential barriers to this approach were explored using a focus group with the participating IP home care team, individual interviews with 8 managers and a survey of 272 health professionals from the primary care organization. A hybrid process of inductive and deductive thematic analysis was used and data were triangulated across all sources.
Family caregivers reported lack of agreement on the nature of the decision to be made, a disconnection between home care services and relatives' needs, and high cost of long-term care alternatives. Factors influencing their decision included their ability to provide care for their relative. While they felt somewhat supported by the IP home care team, they also felt pressured in the decision. Overall, they did not perceive they had been exposed to IP-SDM but agreed that it was applicable in this context. Results from the survey, focus group and interviews with health professionals and managers indicated they all had a favourable attitude towards IP-SDM but many barriers hampered its implementation in their practice.
The family caregivers in this study did not experience IP-SDM when relocating their relative. Added to results obtained with health professionals and managers, this highlights the need for an effective intervention targeting identified barriers to implementing IP-SDM in this context.
在一项探索性案例研究的背景下，作者评估了家庭照顾者对其亲属搬迁决策过程以及跨专业共同决策方法（IP-SDM）适用性的看法。他们还评估了卫生专业人员和卫生管理人员对IP-SDM的看法。
2010年11月至2011年10月，我们与加拿大魁北克市一个大型初级卫生保健组织中一个专门负责老年人的IP家庭护理团队（该案例）合作。我们确定了他们的六位客户，这些客户在过去一年中面临是否居家或搬到长期护理机构的决策，并采访了他们的家庭照顾者。我们探讨了他们在亲属搬迁方面所经历的决策过程以及他们对IP-SDM在此背景下适用性的看法。通过与参与的IP家庭护理团队进行焦点小组讨论、对8名管理人员进行个人访谈以及对初级保健组织的272名卫生专业人员进行调查，探讨了对IP-SDM的态度以及该方法的潜在障碍。采用归纳和演绎主题分析的混合过程，并对所有来源的数据进行三角验证。
家庭照顾者报告称，在要做出的决策性质上缺乏共识，家庭护理服务与亲属需求之间脱节，以及长期护理替代方案成本高昂。影响他们决策的因素包括他们照顾亲属的能力。虽然他们感到IP家庭护理团队在一定程度上给予了支持，但他们在决策中也感到有压力。总体而言，他们觉得自己没有接触到IP-SDM，但同意它在此背景下是适用的。对卫生专业人员和管理人员的调查、焦点小组讨论及访谈结果表明，他们都对IP-SDM持积极态度，但许多障碍阻碍了其在实践中的实施。
本研究中的家庭照顾者在亲属搬迁时未经历IP-SDM。结合卫生专业人员和管理人员的研究结果，这凸显了需要针对在此背景下实施IP-SDM的已确定障碍进行有效干预。
