Purpose: Multidisciplinary care and the engagement of patients as partners in their own care are increasingly seen as two key elements of high-quality and cost-effective healthcare services. However, information is lacking about the intentions of providers in the various professions to engage in an interprofessional approach to shared decision making (IP approach to SDM), especially in the context of home care for elderly patients.
Method: In a large home-care organization in Quebec City, Canada, We conducted a mixed-methods study involving: i) a survey of all healthcare providers, ii) a focus group of an interprofessional team within the organization, and iii) individual interviews with managers, representing the meso-level in the organization. Our survey questionnaire was based on the Theory of Planned Behaviour and assessed attitude, subjective norm, perceived behavioural control and behavioural intention regarding an IP approach to SDM. Also, individual managers and a provider focus group were shown a video about IP approach to SDM and interviewed about barriers and facilitators to adopting an IP approach to SDM. We used descriptive statistics, measured internal consistency and conducted multivariate analysis. We analysed qualitative data using a adapted coding framework of barriers and facilitators to SDM.
Result: Of 423 providers from various professions, 269 completed the survey (65%) and one interprofessional team of seven attended the focus group. Eight of the 20 managers were interviewed. On a scale of -3 (strongly disagree) to +3 (strongly agree), the mean intention to engage in IP approach to SDM in home care for all participants was 1.42+1.39. All the theory-based variables (i.e., attitude, subjective norm, perceived behavioural control) influenced this intention (R2 =57%; p≤0.002). However, the level of influence varied from one profession to another. Commonly-perceived barriers to implementing an IP approach to SDM in home care included lack of time, lack of team cohesion, and high staff turnover. Commonly-perceived facilitators included team cohesion and shared tools.
Conclusion: Most health providers intend to engage in an IP approach to SDM in home care. However, factors influencing this intention vary among the professions, variations that that may explain why the engagement of patients as partners in their own care has not yet happened in contexts requiring multidisciplinary health care. These results will inform the design of future tailored SDM implementation interventions.
See more of: The 34th Annual Meeting of the Society for Medical Decision Making