Factors influencing shared decision-making within long-term care facilities: A person-centered nursing framework

Abstract

Background Shared decision-making, a communicative process to reach decisions based on informed preferences, evidence, and co-created goals, improves care satisfaction and patients’ quality of life. However, shared decision-making has not been widely implemented in long-term care facilities, and few studies have examined how to promote the shared decision-making practice. This study aimed to identify the influencing factors of shared decision-making based on the person-centered nursing framework in long-term care facilities. Methods A total of 300 staff (nursing staff, social workers, and personal care workers) in 13 Korean long-term care facilities were participated in this study. Data from 280 respondents were finally analyzed, excluding the respondents with missing values. Data were collected using structured questionnaires that included items on shared decision-making, personal factors (e.g., knowledge about dementia, person-centered attitude, and communication behavior), care environmental factors (e.g., person-centered climate, staffing level, effective staff relationship, supportive supervisor, and power-sharing) of the facilities. Multilevel linear regression analyses were performed using Mplus Version 8.8. Results The mean shared decision-making score was 35.78 (range 8–45). Staff with at least one person-centered education (β = 0.198, p = 0.034), higher person-centered attitude score (β = 0.201, p = 0.007) and higher communication behavior score (β = 0.242, p < 0.001) were more likely to report a higher shared decision-making score. In addition, staff who recognize their care environment is more person-centeredness were more likely to report a higher shared decision-making score (β = 0.416, p < 0.001). Conclusions This study highlights that general (e.g., person-centered education), personal (e.g., person-centered attitude, and communication behavior) and care environmental (e.g., person-centered climate) factors could influence shared decision-making for long-term care residents. These findings could be foundational evidence for facilitating shared decision-making practice in long-term care settings.