Decision aids for home and community care: a systematic review

Abstract

ObjectivesDecision aids (DAs) for clients in home and community care can support shared decision-making (SDM) with patients, healthcare teams and informal caregivers. We aimed to identify DAs developed for home and community care, verify their adherence to international DA criteria and explore the involvement of interprofessional teams in their development and use.DesignSystematic review reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Data sourcesSix electronic bibliographic databases (MEDLINE, Embase, CINAHL Plus, Web of Science, PsycINFO and the Cochrane Library) from inception to November 2019, social media and grey literature websites up to January 2021.Eligibility criteriaDAs designed for home and community care settings or including home care or community services as options.Data extraction and synthesisTwo reviewers independently reviewed citations. Analysis consisted of a narrative synthesis of outcomes and a thematic analysis. DAs were appraised using the International Patient Decision Aid Standards (IPDAS). We collected information on the involvement of interprofessional teams, including nurses, in their development and use.ResultsAfter reviewing 10 337 database citations and 924 grey literature citations, we extracted characteristics of 33 included DAs. DAs addressed a variety of decision points. Nearly half (42%) were relevant to older adults. Several DAs did not meet IPDAS criteria. Involvement of nurses and interprofessional teams in the development and use of DAs was minimal (33.3% of DAs).ConclusionDAs concerned a variety of decisions, especially those related to older people. This reflects the complexity of decisions and need for better support in this sector. There is little evidence about the involvement of interprofessional teams in the development and use of DAs in home and community care settings. An interprofessional approach to designing DAs for home care could facilitate SDM with people being cared for by teams.PROSPERO registration numberCRD42020169450.

Engagement of Older Adults Receiving Home Care Services and Their Caregivers in Health Decisions in Partnership With Clinical Teams: Protocol for a Multimethod Study to Prioritize and Culturally Adapt Decision Aids for Home Care

“…The main limitation is that the PtDAs we will prioritize have been identified in a systematic review of published literature [ 42 ]. It is therefore possible that these PtDAs do not represent all the current or emerging difficult decisions faced by older adults, their families, and stakeholders.…”

“…We recently completed a systematic review of PtDAs developed for home care [ 42 ]. For them to reach the largest proportion of people who can benefit from them, PtDAs for home care use must be analyzed for their scalability.…”

“…ISSaQ is a list of 37 items covering 12 essential components of scalability, such as evidence on the effectiveness of the innovation, its characteristics, its acceptability, its adaptability, and the quantifiable costs and benefits of scaling ( Multimedia Appendix 1 , in French only). We will therefore use the ISSaQ to assess the scalability of each of the 33 PtDAs developed for home care that were identified in our systematic review [ 42 ].…”

“…First, we will retrieve all available information on each of the PtDAs included in our systematic review by searching for publications. A total of 2 team members will then independently extract the characteristics of the PtDAs (eg, type, purpose, decision point, target population) and complete the ISSaQ scalability assessment grid for all 33 PtDAs identified in the literature [ 42 ]. Any disagreements will be discussed with a third team member to reach a consensus.…”