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BMJ Open. 2017 Nov 12;7(11):e016400. doi: 10.1136/bmjopen-2017-016400.

Decisional needs assessment of patients with complex care needs in primary care: a participatory systematic mixed studies review protocol.

Author information

1
Department of Family Medicine, McGill University, Montréal, Québec, Canada.
2
Department of Family Medicine and Emergency Medicine, Université Laval, Montréal, Québec, Canada.
3
McGill Library, McGill University, Montréal, Québec, Canada.
4
Department of Family Medicine, Université de Sherbrooke, Canada.
5
Family and Emergency Medicine, Université de Montréal, Canada.
6
École de travail social, Université de Sherbrooke, Canada.
7
Beatitude Patient engagement in research, Sherbrooke, Canada.
8
Jewish General Hospital, Montréal, Québec, Canada.
9
Faculty of Pharmacy, Université Laval, Montréal, Québec, Canada.
10
Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, United States.
11
Centre de Science Politique et de Politique Comparée, Université catholique de Louvain, Belgique.
12
Université de Lausanne, Switzerland.
13
Japan National Center for Geriatrics & Gerontology, Obu, Japan.
14
Université d'Aix-Marseille, France.
15
Heidelberg University Hospital, Germany.

Abstract

INTRODUCTION:

Patients with complex care needs (PCCNs) often suffer from combinations of multiple chronic conditions, mental health problems, drug interactions and social vulnerability, which can lead to healthcare services overuse, underuse or misuse. Typically, PCCNs face interactional issues and unmet decisional needs regarding possible options in a cascade of interrelated decisions involving different stakeholders (themselves, their families, their caregivers, their healthcare practitioners). Gaps in knowledge, values clarification and social support in situations where options need to be deliberated hamper effective decision support interventions. This review aims to (1) assess decisional needs of PCCNs from the perspective of stakeholders, (2) build a taxonomy of these decisional needs and (3) prioritise decisional needs with knowledge users (clinicians, patients and managers).

METHODS AND ANALYSIS:

This review will be based on the interprofessional shared decision making (IP-SDM) model and the Ottawa Decision Support Framework. Applying a participatory research approach, we will identify potentially relevant studies through a comprehensive literature search; select relevant ones using eligibility criteria inspired from our previous scoping review on PCCNs; appraise quality using the Mixed Methods Appraisal Tool; conduct a three-step synthesis (sequential exploratory mixed methods design) to build taxonomy of key decisional needs; and integrate these results with those of a parallel PCCNs' qualitative decisional need assessment (semistructured interviews and focus group with stakeholders).

ETHICS AND DISSEMINATION:

This systematic review, together with the qualitative study (approved by the Centre Intégré Universitaire de Santé et Service Sociaux du Saguenay-Lac-Saint-Jean ethical committee), will produce a working taxonomy of key decisional needs (ontological contribution), to inform the subsequent user-centred design of a support tool for addressing PCCNs' decisional needs (practical contribution). We will adapt the IP-SDM model, normally dealing with a single decision, for PCCNs who experience cascade of decisions involving different stakeholders (theoretical contribution). Knowledge users will facilitate dissemination of the results in the Canadian primary care network.

PROSPERO REGISTRATION NUMBER:

CRD42015020558.

KEYWORDS:

interprofessional care; patients with complex care needs; primary care; shared decision making

PMID:
29133314
PMCID:
PMC5695438
DOI:
10.1136/bmjopen-2017-016400
[Indexed for MEDLINE]
Free PMC Article

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