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1. Identify 9 essential elements of shared decision making
2. Discuss family and staff differences in definitions of problems
Bi-weekly interdisciplinary team (IDT) meetings are a requirement in hospice but can at times be a source of frustration for staff, who spend several hours in them and perceive them to have limited utility.
Shared decision making (SDM) is a central tenet of hospice, yet patient and family participation in plan-of-care meetings is rare. As part of a clinical trial involving family in IDT meetings, the objective of this study was to analyze the use of SDM in IDT meetings.
Family members who participated in IDT meetings in four hospice agencies between 2008 and 2021 were interviewed and their meetings were audio-recorded and transcribed. A framework analysis identified elements of SDM and the benefits and barriers perceived by family. A consensus coding process was used between two coders and the study principal investigator.
Sixty-two hospice IDT meetings were transcribed and coded. The least often observed SDM elements were discussion of risks and benefits for potential solutions and the discussion of patient and family values. Family members and staff had differing ideas of presenting problems. Family members were interviewed about their experience in the meetings and expressed both appreciation and frustration with the experience.
IDT meetings would benefit from an efficient structure to support informed discussion, including the definition of presenting problems. Additionally, a pre-meeting process to prioritize cases needing more discussion would seem valuable. Similarly, a standard SDM process could provide a supportive discussion framework for the elements of SDM. Finally, the meetings could benefit from documentation tools supporting rapid information sharing, eliminating “verbal reports” and providing time for problem solving.
Advanced prioritization, a shared information tool, and a standardized SDM structure could result in a more efficient environment for family participation and SDM.
© 2022 Published by Elsevier Inc.