Improving shared decision-making in advance care planning: Implementation of a cluster randomized staff intervention in dementia care

Deconstructing the Complexities of Advance Care Planning Outcomes: What Do We Know and Where Do We Go? A Scoping Review

“…[115][116][117] Clinician training interventions included communication and shared decision-making training and conversation pocket guides. 109,[118][119][120][121] One study included electronic health record templates and a family discussion guide. 89…”

Enhancing shared and surrogate decision making for people living with dementia: A systematic review of the effectiveness of interventions

“…Two studies assessed interventions related to enteral feeding in advanced dementia, a controlled before and after study 37 and a randomized trial 38 . Six studies evaluated interventions related to ACP with either caregivers alone or PLwD‐caregivers dyads; these included one controlled before and after study 39 and five randomized trials 40‐44 . All were undertaken in either the USA, the UK or Belgium.…”

“…Other studies included people living with later stages of dementia, also as dyads, 40,41 and one study included only caregivers as participants for those with late‐stage dementia 42 . The remaining two studies 39,43 detail approaches that could be employed with PLwD, caregivers or both as the course of dementia progressed. A range of evaluation measures were used, including decisional conflict, 42 frequency of relevant discussions 39,43 the quality of communication, 40 levels of SDM, 39,43 the number of palliative care domains discussed, 40‐42 family report of concordance with clinicians on the primary goal of care, 40 decision satisfaction 40,42,44 and dyadic functioning 44 .…”

“…The assessment of the five RCTs against the MMAT is shown in Table 4. The study presented by Ampe et al, 39 mirrors the RCT from Goossens et al, 43 in that they both only consider nursing home staff as participants and not PLwD. Both studies used blinded assessors but were unclear in describing the method of randomization.…”

“…The work of Ampe et al 39 is built upon by Goossens et al 43 where the WeDECide and WeDECide Optimized practitioner training interventions are described, respectively. The ‘optimized’ version 43 aimed to actively emphasize the importance of involving PLwD and family members in communication. These studies use audio‐recorded ACP consultations to examine the process of SDM.…”