Here is the standardised PICO analysis for the fifty-fourth uploaded article:
Full Title
Evaluation of a Novel Decision Guide “Go to the Hospital or Stay Here?” for Nursing Home Residents and Families: A Randomized Trial
Authors: Ruth M. Tappen, Sarah M. Worch, David O. Newman, Debra Hain
Journal: Research in Gerontological Nursing, 2020; 13(6): 309–319
DOI: 10.3928/19404921-20201002-01
Type of Study
Randomised controlled trial (mixed-methods design) conducted across 15 U.S. long-term care facilities
PICO Summary
Population (P)
- Nursing home residents capable of making decisions (screened with Mini-Cog), and family members of those unable to participate
- 192 participants: 128 residents and 64 family members
- Inclusion: English, Spanish, or Haitian Creole literacy, regular visitor status for family, and absence of significant cognitive impairment
Intervention (I)
- Use of a newly developed decision aid: “Go to the Hospital or Stay Here?”
- 13-page, large-print, person-centred guide
- Based on interviews with 271 residents, families, and providers
- Covered risks/benefits of hospital vs in-place care, myths (e.g. bed holding), services available on-site, and rights/preferences
- Delivered by a trained interventionist who explained the content and encouraged reflection and discussion
Comparison (C)
- Control group: received usual care without the guide
- No structured discussion about transfer decisions was provided to controls
Outcomes (O)
Primary Outcomes:
- Knowledge of risks/benefits (22-item test)
- Significantly higher in intervention group posttest (mean = 17.4 vs. 15.8; p = 0.006)
- Decisional conflict (16-item validated scale)
- Significantly lower in intervention group posttest (mean = 8.95 vs. 15.73; p = 0.001)
- Pre/post decrease within the intervention group also significant (p < 0.001)
Secondary Outcomes:
3. Preparation for decision making
- Surprisingly declined slightly at follow-up (mean score 39.6 to 36.0; p = 0.046), likely reflecting increased awareness of complexity
- Stated preference for staying in the nursing home vs. hospitalisation
- 72% preferred staying at baseline; rose to 81% posttest, then slightly declined to 79% at follow-up
- Control group rose from 67% to 78% by 3 months
- Hospital transfers
- No statistically significant difference in actual transfers (5 control vs 8 intervention; p = 0.437)
- Evaluation of the Guide
- 85% found it “helpful” or “very helpful”
- 55% reviewed it again; 26% shared it with others
Findings Summary
This trial showed that a brief, person-centred, narrative-style decision aid can:
- Improve knowledge
- Reduce decisional conflict
- Support values clarification and preference stability
However:
- The guide did not significantly reduce hospitalisation rates, likely due to implementation at the individualrather than organisational/systemic level
- Preparation scores declined, potentially reflecting an increased appreciation of the complexity of the decision
Participants valued the guide, shared it, and re-read it—indicating it met a felt need for structured information.
Conclusion
This was the first trial of a decision aid for acute transfer choices in nursing home settings. It showed strong acceptability and cognitive/affective benefit, but no impact on hospitalisations. Future research should test whole-of-facility implementation, integrate with clinical triggers, and explore impact in diverse cultural groups .
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