BMC Palliative Care
Volume 7
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Abstract (provisional)
Background
Most people prefer home palliation but die in an institution. Some experience decisional conflict when weighing options regarding place of care. Clinicians can identify decisional needs and provide decision support, yet generally lack skills and confidence in doing so. This study aims to determine whether the quality of clinicians' decision support can be improved with a brief, theory-based, skills-building intervention.
Theory:
The Ottawa Decision Support Framework (ODSF) guides an evidence based, practical approach to assist clinicians in providing quality decision support. The ODSF proposes that decisional needs [uncertainty, knowledge, values clarity, support, personal characteristics] strongly influence the quality of decisions patients make. Clinicians can improve the quality of those decisions by providing decision support to address decisional needs [clarify decisional needs, provide facts, probabilities, clarify values, support/guide deliberation, monitor/facilitate progress].
Methods
The efficacy of a brief education intervention will be assessed in a two-phase study. In phase one a focused needs assessment will be conducted with key informants. Phase two is a randomized control trial where clinicians will be allocated to an intervention or control group. The intervention, informed by a focused needs assessment, knowledge transfer best practices and the ODSF, comprises an online tutorial; an interactive skills building workshop; a decision support protocol; performance feedback, and educational outreach. Participants will be assessed: a) at baseline (quality of decision support); b) after the tutorial (knowledge); and c) four weeks after the other interventions (quality of decision support, intention to incorporate decision support into practice and perceived usefulness of intervention components). Between group differences in the primary outcome (quality of decision support scores) will be analyzed using ANOVA.
Discussion
Few studies have investigated the efficacy of an evidence-based, theory guided intervention aimed at assisting clinicians to strengthen their patient decision support skills. Expanding our understanding of how clinicians can best support palliative patients' decision-making will help to inform best practices in patient-centered palliative care. There is potential transferability of lessons learned to other care situations such as chronic condition management, advance directives and anticipatory care planning. Should the efficacy evaluation reveal clear improvements in the quality of decision support provided by clinicians who received the intervention, a larger scale implementation and effectiveness trial will be considered.
Trial registration: This study is registered as NCT00614003
The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.
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Study protocol
on Google Scholar
