Full title of the project
ScaLing up sharEd decision makinG for pAtient-centred Care

Most Canadian older adults lived in private households and want to stay at home as they age. Aging at home optimizes older adults’ health, independence, sense of well-being, and social connectedness. However, with declining health and autonomy, many older adults receive informal or formal care at home. Home care is a setting where seniors/caregivers face difficult decisions that significantly affect wellbeing. Shared decision making (SDM) is a collaborative process whereby healthcare providers support clients in making decisions informed by best evidence and what matters most to them. Although SDM results in better outcomes, most Canadians do not experience SDM and even fewer seniors. To benefit more Canadians, SDM needs to be scaled up. However, there is a persistent failure to do so as scaling up remains an understudied phase of knowledge translation. Since 2007, I have evaluated the implementation of SDM in home care with an emphasis on local/regional context and demonstrated its positive impact. I now propose to reduce knowledge gaps about scaling up SDM in home care across Canada.
Our research question is “What are the steps to scaling up access to shared decision making for a majority of older Canadians?” Our objectives are to determine the most difficult decisions faced by older Canadians receiving home and community care and their caregivers, design and pilot a decision support intervention, and using the best available evidence on scaling up, scale up the intervention across 5 Canadian jurisdictions.

The program has 5 principal aims corresponding to separate phases. In the first phase, in partnership with patients, healthcare professionals and decision-makers, we seek a consensus on the most difficult decisions faced by older adults and their caregivers in the home care context. In the second phase, we review existing decision support interventions targeting older people in home care and select the closest match for the identified priority decision using a Delphi process; we identify behaviour changes and policy changes associated with the decision, select appropriate behaviour change mechanisms, and adapt or design a new decision support intervention. Concurrently, we review the literature on scaling up healthcare interventions using an environmental scan, a realist review, a living review and a review of reviews, and develop a scale-up plan. In the third and fourth phase, we a) assess the effectiveness, validate feasibility, acceptability and scalability of LEGACy, and b) conduct a pragmatic stepped-wedge trial to scale up LEGACy in five provinces in Canada, and ensure ongoing monitoring, process evaluation and tailoring of the scaled-up intervention. The aims 5 is to build capacity in the practice and science of scaling up and SDM. We will train scientists, empower and educate patients, and disseminate knowledge as we produce it.

The final outputs of the program will be a validated and sustainable intervention that addresses one of the most difficult decision faced by older Canadians in home and community care implemented across the country; a comprehensive guide to the design, implementation and scaling-up of decision support interventions; and a new generation of experts schooled in the science of scaling up.

Sabrina Guay-Bélanger, Centre de recherche sur les soins et les services de première ligne de l’Université Laval (CERSSPL-UL)
Karine Plourde, Centre de recherche sur les soins et les services de première ligne de l’Université Laval (CERSSPL-UL)
Project team
France Légaré, MD, Université Laval
Patrick Archambault, Université Laval
Ali Ben Charif, Université Laval
Marie-Claude Boily, Imperial College (London, England)
Emelie Braschi, University of Ottawa/Université d'Ottawa
Emmanuelle Careau, Université Laval
Angela Coulter, University of Oxford (England)
Suzanne Dupuis-Blanchard, Université de Moncton
Lyle J. Fagnan, Oregon Health & Science University
Audrey Ferron Parayre, University of Ottawa/Université d'Ottawa
Pierre-Gerlier Forest, University of Calgary
Anik Giguère, Université Laval
Ian Graham, University of Ottawa/Université d'Ottawa
Gary Groot, University of Saskatchewan
Jayna Holroyd-Leduc, University of Calgary
Paul Nolyoke, Saint Elizabeth Health Care
Allyson Jones, University of Alberta
Eric Kavanagh, Université Laval
Maude Laberge, Université Laval
John Lavis, McMaster University
Hélène Lee-Gosselin, Université Laval
Fabiana Lorencatto, London's Global University Centre Behaviour Change
Andrew Milat, University of Sydney
Léon Nshimyumukiza, Université Laval
Jean-Sébastien Paquette, Université Laval
Véronique Provencher, Université de Sherbrooke
Vardit Ravitsky, Université de Montréal
Louis-Paul Rivest, Université Laval
Geneviève Roch, Université Laval
Dawn Stacey, University of Ottawa/Université d'Ottawa
Sharon Straus, University of Toronto
Annette Totten, Oregon Health & Science University
Holly O. Witteman, Université Laval
Luke Wolfenden, University of Newcastle
A large team of knowledge user
Project Financing Agency
Institut Recherche en santé du Canada (IRSC)
Canadian Institutes of Health Research (CIHR)

Start and end dates for project financing