Efficacy of a Training Intervention on the Quality of Case Managers Nurses Decision Support for Patients Deciding about the Place of Care at the End-of-Life: A Randomized Control Study & Efficacy of an Evidence Informed, Theory-based Training Intervention on the Quality of Clinicians’ Decision Support for Patients Deciding about Place of End-of-Life Care: A Randomized Control Trial

Purpose

To evaluate the efficacy of a theory driven, framework-based, multifaceted training intervention designed to enhance the quality of nurses decision support skills regarding end-of-life place of care for adults with terminal cancer. This study aims to determine whether the quality of nurses decision support can be improved with a theory-based skills-building intervention.

The specific aims of this research study are:

Specific aim 1: To identify factors affecting the likelihood of nurses integrating decision support principles into their practice.

Specific aim 2: To determine the quality of decision support nurses provide.

Specific aim 3: To design and evaluate components of a decision support training intervention.

A follow-up project looked at the clinicians’ roles to determine whether the quality of clinicians decision support for patients considering place of care at end-of-life can be improved with interventions designed to translate decision support knowledge for use in clinical practice.

This study aimed to determine whether the quality of clinicians’ decision support can be improved with a brief, framework-based, skills-building intervention.

Findings

Terminal cancer patients’ decision making about place of care is complex, with numerous determinants influencing the final choice. Nurses believe they have a role in providing decision support, but lack skills, confidence and tools.  These barriers can be addressed with a multi-faceted educational program and a patient decision aid. Practitioners who received training overcame knowledge and skill gaps. Improvements in the quality of decision support can be accomplished by adding 3 minutes to the interaction duration.  Extra training did not affect intentions to provide decision support, which were already high.

Implementation of the intervention on a broader scale may help to improve end of life care planning which might lead to better quality of life for patients and families, more effective use of health resources and services, and less emergent contact with health care providers (such as after-hours calls to case managers, physicians and emergency room visits and admissions).  However, full implementation of the multi-faceted intervention requires consideration of broad system perspectives. To ensure sustainability and responsiveness to patient needs, contextual barriers within practice environments with accompanying macro level policy barriers need to be addressed and patient outcomes evaluated.