We DECide Optimized. Verbeteren van gedeelde besluitvorming in vroegtijdige zorgplanning voor personen met dementie in woonzorgcentra

Background: Advance care planning is the dynamic and continuous process of discussing a person's wishes and preferences, in consultation with everyone involved, and becomes particularly critical when decisions can no longer be made autonomously. Because of the gradual loss of function, people with dementia must discuss advance care planning. Ideally, both the person with dementia and care professionals work together to make a joint decision about care through a process called shared decision-making. Unfortunately, nursing home staff feel uncomfortable discussing advance care planning and using the principles of shared decision-making. For these reasons, we implemented the communication training 'We DECide optimized' in Flemish nursing homes. The primary objective was to increase the level of shared decision-making in advance care planning conversations. Secondary objectives were to measure participants' perceptions of the importance, competence and frequency of advance care planning discussions, as well as residents' and relatives' observations of the level of shared decision-making in their conversations. At the organizational level, advance care planning policies, support from management and the use of shared decision-making skills in team meetings were also assessed. However, the results of these organizational assessments are not included in this dissertation. Methods: The training consisted of 2 workshops of 4 hours each, with a homework assignment between sessions. Participants received a theoretical introduction to advance care planning and shared decision-making, engaged in role-playing exercises, and compared their policies with best practices. Two trainers, one with a background in psychology and the other in nursing, delivered the training sessions. Participating wards received support materials to encourage residents and their families to initiate discussions. The study used a cluster randomized controlled design and involved 65 Flemish nursing home wards (311 staff members). Data were collected using a pretest-posttest model, with measurements up to 9 months after the training. Results: 'We DECide Optimized' sustainably increased the level of shared decision-making in advance care planning conversations, without increasing the time spent on these discussions. After the training, participants felt more competent and placed more importance on advance care planning. The way advance care planning was discussed in team meetings was similar to how it was discussed between staff and residents. Limitations were the level of attrition after the training and the limited generalizability of our findings due to limited information on (dis)similarities between (non)participating nursing homes. Conclusion: Care professionals can benefit from training in shared decision-making for advance care planning with people with dementia in nursing homes.