Aged care residents’ beliefs about their control over decisions and whether medications are working play a significant role in the shared decision-making process, new University of Sydney research has found.
Shared decision-making is where the person, their representative and health care professionals share information and decisions and agree on a course of action.
The study, which responds to medication management concerns highlighted by the aged care royal commission, is the first to explore aged care residents’ perspectives of shared decision-making in medication management. It involved face-to-face interviews with 31 residents at six aged care homes in Sydney.
Lead researcher Dr Mouna Sawan said some residents deferred control or participation in medication-related decisions to others because of assumptions regarding the patient-physician role or their own capacity.
“Others perceived they could maintain their right to participate in medication-related decisions to maintain the need to be an advocate for themselves and voice their preferences,” Dr Sawan told Australian Ageing Agenda.
“This study highlights that residents’ beliefs in having control over decisions is a key factor influencing overall shared decision-making processes,” said Dr Sawan, a research fellow at the University of Sydney.
“Therefore, it is important to understand residents’ beliefs and values regarding their role in medication decisions to address any misconceptions and strengthen participation.”
The research also found that residents’ beliefs that their medication was working or not causing harm influenced their participation in shared decision-making.
“A number of residents wished to remain on medication because of the perception that they needed medication or fear that symptoms would return if they underwent withdrawal. For this reason, it is important to identify the resident’s beliefs and values towards medications, particularly for residents who are ambivalent, prior to sharing information with the resident,” Dr Sawan said.
Successful implementation in aged care
Shared decision-making is an important part of achieving the safety and quality use of medication and its implementation requires a total acceptance by aged care providers, managers, registered nurses, primary care physicians and other health professionals that have a role in medication decisions, she said.
“From the perspective of aged care staff, a reported barrier to shared decision-making was staff not knowing how to lead conversations with residents and their representatives regarding the harms versus benefits of high-risk medication.
“Therefore, aged care providers need to be proactive and take up measures – including education and training of staff and health professionals to engage residents in shared decision-making – to identify and document residents’ goals, preferences and beliefs about medications. The information can then be used to align medication decisions with residents’ goals and advance care directives,” Dr Sawan said.
She said the culture of aged care homes also needed to:
- respect residents’ right to take part in shared decision-making
- promote open communication between residents and health care professionals
- be attentive to residents’ goals and concerns.
“It is important for resources to be allocated to support the implementation of shared decision-making and that existing national policies provide aged care homes and health care professionals incentives to engage in shared decision-making,” Dr Sawan said.
While not all residents want to participate in shared decision-making, they or their designated surrogate decision-maker need to be given the choice to participate at a level they feel comfortable with and have that choice respected, she said.
5-step shared decision-making framework for aged care
To guide implementation of shared decision-making in aged care homes, Dr Sawan and her colleagues have developed a five-step framework:
- Assess – a health care professional assesses the resident’s capacity, beliefs, values and preference for shared decision-making
- Approach – the health care professional works with the resident and surrogate decision-maker to decide the approach, such as relinquish the decision to the health care professional or proceed with discussing benefits and harms of treatment
- Advise – evidence-based information about the benefit and harms of medications is discussed for those wishing to proceed
- Align – medications are aligned with residents’ goals and advance care directives to ensure person-centred medication decisions
- Action – agreed decisions are actioned and aged care staff and health care professionals monitor a resident’s response to medications.
For further information please contact Dr Mouna Sawan at email@example.com.
Perspectives of residents on shared decision making in medication management: A qualitative study is published in International Psychogeriatrics.