Improving Decision Making On Location of Care With the Frail Elderly and Their Caregivers (DOLCE)

• ClinicalTrials.gov Identifier: NCT02244359
• Recruitment Status: Completed
• First Posted: September 19, 2014
• Last Update Posted: August 25, 2016
• Sponsor: CHU de Quebec-Universite Laval
• Collaborators: TVN 2013 Core Research Grant Program; Ministere de la Sante et des Services Sociaux; Health and Social Services Agency, Montreal
• Information provided by (Responsible Party): France Legare, CHU de Quebec-Universite Laval

Study Description

Brief Summary:

One of the toughest decisions faced by the frail elderly in Canada is whether to stay at home or move to a care facility. It is certainly difficult to make this decision alone, but can be even harder if someone else makes it for you. Shared decision making is when, instead of making decisions for the patient, healthcare professionals share information about what the evidence says, and they talk about what's important with the patient, and then make the decision together. In the case of the frail elderly in home care services, there are many health care professionals involved, e.g. the doctor, nurse and social worker. In this case decisions should be shared by all the professionals involved with the elderly person along with his or her caregivers. Unfortunately, in this context, shared decision making rarely occurs.

We have designed a training program that teaches interprofessional teams how to share decisions with their frail elderly patients, and tested it in one Quebec City and one Edmonton home care team. This project tests the training program on a broader scale with 16 home care teams attached to community health centres across the province of Quebec, and will compare the results with what happens when no one has completed the training (usual care). Home care is a rapidly growing sector and this study will lay the foundations for a national strategy to ensure that no one has to make this difficult decision alone.

Condition or disease	Intervention/treatment	Phase
Decision Process About the Location of Care Among Frail Elderly	Behavioral: Training; Behavioral: Usual care	Not Applicable

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 455 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: Single (Participant)
• Primary Purpose: Health Services Research
• Official Title: Improving the Decision Making Process About Location of Care With the Frail Elderly and Their Caregivers
• Study Start Date: September 2014
• Actual Primary Completion Date: August 2016
• Actual Study Completion Date: August 2016

Arms and Interventions

Arm	Intervention/treatment
Experimental: Training; Online tutorial, decision aid and interactive workshop	Behavioral: Training
Usual care; Usual care	Behavioral: Usual care

Outcome Measures

Primary Outcome Measures :

1. The assumed role in the decision making process, and the preferred and chosen options. [ Time Frame: 3 to 6 months ]
   We will use the modified version of the Control Preferences Scale designed to assess the assumed role in the decision making process reported by the client.

Eligibility Criteria

• Ages Eligible for Study: 65 Years and older (Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

• Receiving care from the home care team
• Faced the decision about whether to stay at home or move to a care facility in the previous 3 to 6 months
• Able to read, understand and write french or english
• Able to give informed consent
• For the case of clients unable to provide informed consent, their caregivers who was involved into decision making process will be eligible

Exclusion Criteria:

• Clients who cannot provide informed consent (e. g. clients with cognitive impairment) without a caregiver
• Clients who require acute care hospitalization and whom the location of care decision is transferred to hospital-based social services

Contacts and Locations

Locations

Canada

CHU de Québec

Quebec, Canada, G1L 3L5

Sponsors and Collaborators

CHU de Quebec-Universite Laval

TVN 2013 Core Research Grant Program

Ministere de la Sante et des Services Sociaux

Health and Social Services Agency, Montreal

Investigators

• Principal Investigator: France Légaré, MD, PhD; CHUQ Research Center

More Information

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Boucher A, Haesebaert J, Freitas A, Adekpedjou R, Landry M, Bourassa H, Stacey D, Croteau J, Geneviève PG, Légaré F. Time to move? Factors associated with burden of care among informal caregivers of cognitively impaired older people facing housing decisions: secondary analysis of a cluster randomized trial. BMC Geriatr. 2019 Sep 9;19(1):249. doi: 10.1186/s12877-019-1249-1. Erratum in: BMC Geriatr. 2020 Feb 5;20(1):42.

Garvelink MM, Emond J, Menear M, Brière N, Freitas A, Boland L, Perez MMB, Blair L, Stacey D, Légaré F. Development of a decision guide to support the elderly in decision making about location of care: an iterative, user-centered design. Res Involv Engagem. 2016 Jul 19;2:26. doi: 10.1186/s40900-016-0040-0. eCollection 2016.

Garvelink MM, Freitas A, Menear M, Brière N, Stacey D, Légaré F. In for a penny, in for a pound: the effect of pre-engaging healthcare organizations on their subsequent participation in trials. BMC Res Notes. 2015 Dec 8;8:751. doi: 10.1186/s13104-015-1743-2.

Légaré F, Brière N, Stacey D, Bourassa H, Desroches S, Dumont S, Fraser K, Freitas A, Rivest LP, Roy L. Improving Decision making On Location of Care with the frail Elderly and their caregivers (the DOLCE study): study protocol for a cluster randomized controlled trial. Trials. 2015 Feb 12;16:50. doi: 10.1186/s13063-015-0567-7.

• Responsible Party: France Legare, B. Sc. Arch, MD, PhD, CCMF, FCMF, CHU de Quebec-Universite Laval
• ClinicalTrials.gov Identifier: NCT02244359
• Other Study ID Numbers: CORE 2013-56
• First Posted: September 19, 2014
• Last Update Posted: August 25, 2016
• Last Verified: August 2016

Keywords provided by France Legare, CHU de Quebec-Universite Laval:

Shared Decision making; Patient Centred care; Interprofessionalism; Home care; Frail elderly