BMC Med Inform Decis Mak - Decision aids for respite service choices by carers of people with dementia: development and pilot RCT.

Tópicos

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Resumo

CKGROUND: Decision aids are often used to assist individuals confronted with a diagnosis of a serious illness to make decisions about treatment options. However, they are rarely utilised to help those with chronic or age related conditions to make decisions about care services. Decision aids should also be useful for carers of people with decreased decisional capacity. These carers' choices must balance health outcomes for themselves and for salient others with relational and value-based concerns, while relying on information from health professionals. This paper reports on a study that both developed and pilot tested a decision aid aimed at assisting carers to make evaluative judgements of community services, particularly respite care.METHODS: A mixed method sequential study, involving qualitative development and a pilot randomised controlled trial, was conducted in Tasmania, Australia. We undertook 13 semi-structured interviews and three focus groups to inform the development of the decision aid. For the randomised control trial we randomly assigned 31 carers of people with dementia to either receive the service decision aid at the start or end of the study. The primary outcome was measured by comparing the difference in carer burden between the two groups three months after the intervention group received the decision aid. Pilot data was collected from carers using interviewer-administered questionnaires at the commencement of the project, two weeks and 12 weeks later.RESULTS: The qualitative data strongly suggest that the intervention provides carers with needed decision support. Most carers felt that the decision aid was useful. The trial data demonstrated that, using the mean change between baseline and three month follow-up, the intervention group had less increase in burden, a decrease in decisional conflict and increased knowledge compared to control group participants.CONCLUSIONS: While these results must be interpreted with caution due to the small sample size, all intervention results trend in a direction that is beneficial for carers and their decisional ability. Mixed method data suggest the decision aid provides decisional support that carers do not otherwise receive. Decision aids may prove useful in a community health services context.TRIAL REGISTRATION NUMBER: ISRCTN: ISRCTN32163031.

Resumo Limpo

ckground decis aid often use assist individu confront diagnosi serious ill make decis treatment option howev rare utilis help chronic age relat condit make decis care servic decis aid also use carer peopl decreas decision capac carer choic must balanc health outcom salient other relat valuebas concern reli inform health profession paper report studi develop pilot test decis aid aim assist carer make evalu judgement communiti servic particular respit caremethod mix method sequenti studi involv qualit develop pilot randomis control trial conduct tasmania australia undertook semistructur interview three focus group inform develop decis aid randomis control trial random assign carer peopl dementia either receiv servic decis aid start end studi primari outcom measur compar differ carer burden two group three month intervent group receiv decis aid pilot data collect carer use intervieweradminist questionnair commenc project two week week laterresult qualit data strong suggest intervent provid carer need decis support carer felt decis aid use trial data demonstr use mean chang baselin three month followup intervent group less increas burden decreas decision conflict increas knowledg compar control group participantsconclus result must interpret caution due small sampl size intervent result trend direct benefici carer decision abil mix method data suggest decis aid provid decision support carer otherwis receiv decis aid may prove use communiti health servic contexttri registr number isrctn isrctn

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