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J Am Med Dir Assoc. 2014 Apr;15(4):251-5. doi: 10.1016/j.jamda.2013.11.020. Epub 2014 Feb 6.

Development and testing of a decision aid on goals of care for advanced dementia.

Author information

1
Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC; Georgetown University School of Medicine, Washington, DC.
2
Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC.
3
Department of Biostatistics, School of Public Health, University of North Carolina, Chapel Hill, NC.
4
Division of Geriatric Medicine and Center for Aging and Health, University of North Carolina, Chapel Hill, NC.
5
Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC; Division of Geriatric Medicine and Center for Aging and Health, University of North Carolina, Chapel Hill, NC; Palliative Care Program, University of North Carolina, Chapel Hill, NC. Electronic address: lhanson@med.unc.edu.

Abstract

OBJECTIVES:

Decision aids are effective to improve decision-making, yet they are rarely tested in nursing homes (NHs). Study objectives were to (1) examine the feasibility of a goals of care (GOC) decision aid for surrogate decision-makers (SDMs) of persons with dementia; and (2) to test its effect on quality of communication and decision-making.

DESIGN:

Pre-post intervention to test a GOC decision aid intervention for SDMs for persons with dementia in NHs. Investigators collected data from reviews of resident health records and interviews with SDMs at baseline and 3-month follow-up.

SETTING:

Two NHs in North Carolina.

PARTICIPANTS:

Eighteen residents who were over 65 years of age, had moderate to severe dementia on the global deterioration scale (5, 6, or 7), and an English-speaking surrogate decision-maker.

INTERVENTION:

(1) GOC decision aid video viewed by the SDM and (2) a structured care plan meeting between the SDM and interdisciplinary NH team.

MEASUREMENTS:

Surrogate knowledge, quality of communication with health care providers, surrogate-provider concordance on goals of care, and palliative care domains addressed in the care plan.

RESULTS:

Eighty-nine percent of the SDMs thought the decision aid was relevant to their needs. After viewing the video decision aid, SDMs increased the number of correct responses on knowledge-based questions (12.5 vs 14.2; P < .001). At 3 months, they reported improved quality of communication scores (6.1 vs 6.8; P = .01) and improved concordance on primary goal of care with NH team (50% vs 78%; P = .003). The number of palliative care domains addressed in the care plan increased (1.8 vs 4.3; P < .001).

CONCLUSIONS:

The decision-support intervention piloted in this study was feasible and relevant for surrogate decision-makers of persons with advanced dementia in NHs, and it improved quality of communication between SDM and NH providers. A larger randomized clinical trial is underway to provide further evidence of the effects of this decision aid intervention.

KEYWORDS:

Dementia; decision-making; goals of care

PMID:
24508326
PMCID:
PMC3972334
DOI:
10.1016/j.jamda.2013.11.020
[Indexed for MEDLINE]
Free PMC Article

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