• J Am Med Dir Assoc · Apr 2014

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

    • Seth F Einterz, Robin Gilliam, Feng Chang Lin, J Marvin McBride, and Laura C Hanson.
    • Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC; Georgetown University School of Medicine, Washington, DC.
    • J Am Med Dir Assoc. 2014 Apr 1;15(4):251-5.

    ObjectivesDecision 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.DesignPre-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.SettingTwo NHs in North Carolina.ParticipantsEighteen 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.MeasurementsSurrogate knowledge, quality of communication with health care providers, surrogate-provider concordance on goals of care, and palliative care domains addressed in the care plan.ResultsEighty-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).ConclusionsThe 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.Copyright © 2014 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

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