Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Quebec, Canada.
Université de Lyon, Université Claude Bernard Lyon 1, Université Saint-Étienne, HESPER EA 7425, F-69008 Lyon, F-42023, Saint-Etienne, France.
BMC Health Serv Res. 2020 Mar 12;20(1):203. doi: 10.1186/s12913-020-5064-3.
DOLCE (Improving Decision making On Location of Care with the frail Elderly and their caregivers) was a post-intervention clustered randomised trial (cRT) to assess the effect of training home care teams on interprofessional shared decision-making (IP-SDM). Alongside the cRT, we sought to monitor healthcare providers' level of behavioural intention to engage in an IP-SDM approach and to identify factors associated with this intention.
We conducted two cross-sectional surveys in the province of Quebec, Canada, one each at cRT entry and exit. Healthcare providers (e.g. nurses, occupational therapists and social workers) in the 16 participating intervention and control sites self-completed an identical paper-based questionnaire at entry and exit. Informed by the Integrated model for explaining healthcare professionals' clinical behaviour by Godin et al. (2008), we assessed their behavioural intention to engage in IP-SDM to support older adults and caregivers of older adults with cognitive impairment to make health-related housing decisions. We also assessed psychosocial variables underlying their behavioural intention and collected sociodemographic data. We used descriptive statistics and linear mixed models to account for clustering.
Between 2014 and 2016, 271 healthcare providers participated at study entry and 171 at exit. At entry, median intention level was 6 in a range of 1 (low) to 7 (high) (Interquartile range (IQR): 5-6.5) and factors associated with intention were social influence (β = 0.27, P < 0.0001), beliefs about one's capabilities (β = 0.43, P < 0.0001), moral norm (β = 0.31, P < 0.0001) and beliefs about consequences (β = 0.21, P < 0.0001). At exit, median intention level was 5.5 (IQR: 4.5-6.5). Factors associated with intention were the same but did not include moral norm. However, at exit new factors were kept in the model: working in rehabilitation (β = - 0.39, P = 0.018) and working as a technician (β = - 0.41, P = 0.069) (compared to as a social worker).
Intention levels were high but decreased from entry to exit. Factors associated with intention also changed from study entry to study exit. These findings may be explained by the major restructuring of the health and social care system that took place during the 2 years of the study, leading to rapid staff turnover and organisational disturbance in home care teams. Future research should give more attention to contextual factors and design implementation interventions to withstand the disruption of system- and organisational-level disturbances.
Clinicaltrials.gov (NCT02244359). Registered on September 19th, 2014.
DOLCE（通过与体弱老年人及其照顾者改善位置决策来提高决策）是一项干预后集群随机试验（cRT），旨在评估培训家庭护理团队对跨专业共享决策（IP-SDM）的影响。除了 cRT 之外，我们还试图监测医疗保健提供者参与 IP-SDM 方法的行为意向水平，并确定与该意向相关的因素。
我们在加拿大魁北克省进行了两项横断面调查，一项在 cRT 进入和退出时进行。参与 16 个干预和对照地点的医疗保健提供者（例如护士、职业治疗师和社会工作者）在进入和退出时自行填写了一份完全相同的纸质问卷。根据 Godin 等人（2008 年）解释医疗保健专业人员临床行为的综合模型，我们评估了他们参与 IP-SDM 的行为意向，以支持认知障碍老年人及其照顾者做出与健康相关的住房决策。我们还评估了支持他们行为意向的心理社会变量，并收集了社会人口统计学数据。我们使用描述性统计和线性混合模型来解释聚类。
在 2014 年至 2016 年期间，有 271 名医疗保健提供者在研究开始时参加，171 名在研究结束时参加。在进入时，意向水平中位数为 1 至 7 之间的 6（四分位距（IQR）：5-6.5），与意向相关的因素包括社会影响（β=0.27，P<0.0001）、对自己能力的信念（β=0.43，P<0.0001）、道德规范（β=0.31，P<0.0001）和对后果的信念（β=0.21，P<0.0001）。在退出时，意向水平中位数为 5.5（IQR：4.5-6.5）。与意向相关的因素相同，但不包括道德规范。然而，在退出时，新的因素被保留在模型中：在康复工作（β=-0.39，P=0.018）和作为技术员工作（β=-0.41，P=0.069）（与社会工作者相比）。
意向水平较高，但从进入到退出有所下降。与意向相关的因素也从研究开始到研究结束发生了变化。这些发现可能是由于研究期间发生的医疗保健和社会保健系统的重大重组所导致的，这导致家庭护理团队的员工快速更替和组织混乱。未来的研究应更加关注背景因素，并设计实施干预措施，以抵御系统和组织层面干扰的破坏。
Clinicaltrials.gov（NCT02244359）。2014 年 9 月 19 日注册。
