Life In The Slower Lane

Here is the structured PICO analysis for the forty-third article you uploaded:

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Full Title (verbatim and exact):

“We DECide optimized” – training nursing home staff in shared decision-making skills for advance care planning conversations in dementia care: protocol of a pretest-posttest cluster randomized trial

Goossens B, Sevenants A, Declercq A, Van Audenhove C

BMC Geriatrics (2019); 19:33

DOI: https://doi.org/10.1186/s12877-019-1044-z

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Type of Article:

Protocol for a cluster randomised controlled trial

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PICO Analysis:

Population:

• 65 wards across 48 Flemish nursing homes, enrolling 311 staff members
• Target population: nursing home staff, management, and indirectly residents with dementia and their families
• All participating wards supported people with dementia or mixed populations 

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Intervention:

“We DECide optimized” communication training, consisting of:

• Two 4-hour workshops delivered by experienced trainers
• Homework assignment involving practice conversations
• Use of the Three-Talk Model for Shared Decision-Making (SDM): Team Talk, Option Talk, Decision Talk
• Role-play exercises simulating ACP at admission, during daily care, and in crises
• Group discussions to improve ACP policies at ward level
• Information campaign (posters, pocket cards, info sheets) to encourage resident/family engagement 

Workshops were designed to:

• Increase confidence and competence in SDM
• Embed ACP into everyday ward culture and routines
• Provide supporting materials to enable sustainability of practice change

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Comparator:

• Control group: wards receiving no training during the study period
• After data collection, control group was offered the training to ensure parity

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Outcome:

1. Person-centred outcomes:

• Resident/family-reported engagement in ACP conversations
• Use of validated instruments:
  • SDM-Q-9 (resident/family view of decision-making)
  • CollaboRATE (3-item tool on feeling involved in decisions)
• Feedback forms assessed the impact of the information campaign encouraging resident involvement 

2. Process outcomes:

• Primary outcome: Use of SDM in formal ACP conversations, assessed by:
  • OPTION-12 (observer-rated measure of SDM in audio-recorded conversations)
  • SDM-Q-DOC (staff self-rated)
  • Team meeting recordings assessed via the ACCENT tool
• Secondary outcomes:
  • IFC-SDM: measures staff perceptions of importance, competence, and frequency of SDM behaviours
  • ACPQ: measures ACP policy implementation at the ward level
  • SACP: assesses management support for ACP implementation 

3. Health system outcomes (proxy):

• No direct hospitalisation or health economics data collected
• However, process-level outcomes aim to reduce unwanted transfers and improve policy adherence via better shared decision-making and goal-concordant care 

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Summary Conclusion:

This protocol describes a robust, multi-level intervention aimed at increasing shared decision-making in advance care planning (ACP) for residents with dementia in nursing homes. The “We DECide optimized” program trains staff using a structured conversation model, simulation, and reflective policy planning. Key strengths include a cluster RCT design, inclusion of management and direct care workers, and focus on resident/family empowerment. The trial will assess how well SDM is adopted into routine ACP conversations and identify facilitators and barriers to sustained implementation.

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