Shared decision‐making with adults transitioning to long‐term care: A scoping review

Abstract

Background Transitions to long‐term care are challenging for individuals and often associated with a loss of autonomy. Positive experiences are noted, especially when decisions involve the individual in a person‐centred way which are respectful of the person's human rights. One approach which facilitates self‐determination during a transitional period is shared decision‐making, but there is a lack of clarity on the nature and extent of research evidence in this area. Objective The purpose of this scoping review is to identify and document research related to shared decision‐making and transitioning to long‐term care. Methods A comprehensive search in CINAHL, Medline and Psych‐info identified papers which included evidence of shared decision‐making during transitions to a long‐term care setting. The review following the JBI and PAGER framework for scoping reviews. Data were extracted, charted and analysed according to patterns, advances, gaps, research recommendations and evidence for practice. Results Eighteen papers met the inclusion criteria. A body of knowledge was identified encompassing the pattern advancements in shared decision‐making during transitions to long‐term care, representing developments in both the evidence base and methodological approaches. Further patterns offer evidence of the facilitators and barriers experienced by the person, their families and the professional's involved. Conclusions The evidence identified the complexity of such decision‐making with efforts to engage in shared decision‐making often constrained by the availability of resources, the skills of professionals and time. The findings recognise the need for partnership and person‐centred approaches to optimise transitions. The review demonstrates evidence of approaches that can inform future practice and research to support all adult populations who may be faced with a transitional decision to actively participate in decision‐making.

Integrating shared decision-making, expressing preferences and active participation of older adults in primary care nursing: a systematic review of qualitative studies and qualitative meta-synthesis

“…All this is potentially enhanced by professional characteristics that care providers have and might benefit that feeling perceived by older patients. This is consistent with a recent study by Egan et al 57 that places primary care nurses as crucial elements in enhancing the performance of older people in decision-making processes. However, as we also reflected in the results of our study, implementing shared decision-making in older people is challenging 58…”

A qualitative study of family members’ perspectives regarding decision-making for nursing home residents’ care

“…Family members of nursing home residents are highly involved in making decisions regarding resident care (Egan et al, 2023 ; Mortensen et al, 2023 ), and are usually responsible for moving residents to the nursing home (Seiger Cronfalk et al, 2017 ). Family members often hold themselves responsible for monitoring and evaluating the quality of care the resident receives, and they have moral concerns and troubled consciences regarding the resident (Ekström et al, 2019 ; Seiger Cronfalk et al, 2017 ).…”

Fluctuating decision making about aging‐in‐place/long term care planning among older adults

“…AIP planning entails making decisions about the structural feasibility of the home, identification of potential supporters, and determining proximity to healthcare 4,5 . LTC planning entails making decisions about residential communities, financing, and determining fit with perceived future needs 6 …”

“…4,5 LTC planning entails making decisions about residential communities, financing, and determining fit with perceived future needs. 6 Prior research on healthcare decision-making (e.g., endof-life, elective surgery, vaccine use) has often utilized the transtheoretical model of health behavior change which delineates the stages as follows: (1) precontemplation, (2) contemplation, (3) preparation, (4) action, (5) maintenance, and (6) termination. 7 With AIP/LTC decisionmaking, a gap exists in the literature on whether it fits this model.…”