title: Decision aids for respite service choices by carers of people with dementia: development and pilot RCT.
abstract: BACKGROUND
  Decision aids are often used to assist individuals confronted with a diagnosis of a serious illness to make decisions about treatment options. However, they are rarely utilised to help those with chronic or age related conditions to make decisions about care services. Decision aids should also be useful for carers of people with decreased decisional capacity. These carers' choices must balance health outcomes for themselves and for salient others with relational and value-based concerns, while relying on information from health professionals. This paper reports on a study that both developed and pilot tested a decision aid aimed at assisting carers to make evaluative judgements of community services, particularly respite care.
  
  
  METHODS
  A mixed method sequential study, involving qualitative development and a pilot randomised controlled trial, was conducted in Tasmania, Australia. We undertook 13 semi-structured interviews and three focus groups to inform the development of the decision aid. For the randomised control trial we randomly assigned 31 carers of people with dementia to either receive the service decision aid at the start or end of the study. The primary outcome was measured by comparing the difference in carer burden between the two groups three months after the intervention group received the decision aid. Pilot data was collected from carers using interviewer-administered questionnaires at the commencement of the project, two weeks and 12 weeks later.
  
  
  RESULTS
  The qualitative data strongly suggest that the intervention provides carers with needed decision support. Most carers felt that the decision aid was useful. The trial data demonstrated that, using the mean change between baseline and three month follow-up, the intervention group had less increase in burden, a decrease in decisional conflict and increased knowledge compared to control group participants.
  
  
  CONCLUSIONS
  While these results must be interpreted with caution due to the small sample size, all intervention results trend in a direction that is beneficial for carers and their decisional ability. Mixed method data suggest the decision aid provides decisional support that carers do not otherwise receive. Decision aids may prove useful in a community health services context.
  
  
  BACKGROUND
  ISRCTN: ISRCTN32163031.
authors.affiliation: Wicking Dementia Research and Education Centre, Menzies Research Institute, University of Tasmania, Private Bag 121, Hobart, TAS, Australia 7000. Christine.Stirling@utas.edu.au
authors.forename: Christine
authors.initials: C
authors.lastname: Stirling
authors.forename: Susan
authors.initials: S
authors.lastname: Leggett
authors.forename: Barbara
authors.initials: B
authors.lastname: Lloyd
authors.forename: Jenn
authors.initials: J
authors.lastname: Scott
authors.forename: Leigh
authors.initials: L
authors.lastname: Blizzard
authors.forename: Stephen
authors.initials: S
authors.lastname: Quinn
authors.forename: Andrew
authors.initials: A
authors.lastname: Robinson
mesh_terms: D017028:Caregivers / Q000523:psychology*; D003153:Community Health Services / Q000379:methods*; D003661:Decision Support Techniques; D003704:Dementia / Q000628:therapy*; D005069:Evaluation Studies as Topic; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D010865:Pilot Projects; D016730:Program Development; D012144:Respite Care / Q000523:psychology* / Q000600:supply & distribution; D011795:Surveys and Questionnaires