Shared decision-making in dementia care planning: barriers and facilitators in two European countries

ABSTRACT

Background: Shared decision-making (SDM) is a means of allowing people with dementia to take part in making choices, be autonomous and participate in social activities. Involving them in SDM is an important way of promoting social health. However, including families and dementia residents in decision-making can be challenging for care staff working in nursing homes. The objective of this study was to identify barriers and facilitators regarding the implementation of an SDM framework for care planning in two nursing homes, one in Italy and one in the Netherlands.

Methods: Focus group interviews were conducted with healthcare professionals who, after being trained, applied the SDM framework. Content analysis was used to analyze the data.

Results: Six months after the feasibility trial, focus group interviews with healthcare professionals (n = 10 in Italy; n = 9 in the Netherlands) were held. We found 6 themes and 15 categories. Within these themes, facilitators and barriers were identified. The categories of team collaboration, communication skills and nursing home policy were found to be facilitators to the implementation process, whereas regulations, lack of funding and of involvement of family caregivers were the main barriers. Family attitudes towards SDM could be both. The main difference between countries concerned the residents’ cognitive status that influenced their degree of involvement.

Conclusion: Communication skills training for professionals, training of family caregivers, and involvement of the management in the implementation process seem to be crucial factors in successfully implementing SDM in nursing homes, and increasing the involvement of families and dementia residents in decision-making.

KEYWORDS:

• Dementia
• family
• staff
• shared decision-making
• nursing homes

Acknowledgments

Myrra Vernooij-Dassen, Yvonne Engels, Raymond Koopmans and Rabih Chattat designed and supervised the study. Elena Mariani is the primary investigator and responsible for drafting the manuscript. All authors have read and approved the final manuscript. The authors thank all participating researchers and services involved in the IMPACT consortium for their support.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The study was supported by the European Union's Seventh Framework Programme FP7/2007-2013 under grant agreement n°258883.