title: Provider staffing effect on a decision aid intervention.
abstract: This study examined the association between Nurse Practitioner (NP) and Physician Assistant (PA) staffing in nursing homes and the effect of a decision aid regarding feeding options in dementia on the frequency of surrogate-provider discussions and on surrogates' decisional conflict. We compared these outcomes for facilities that had no NPs/PAs, part-time-only NP/PA staffing, and full-time NP/PA staffing. The sample included 256 surrogate decision makers from 24 nursing homes. The decision aid was associated with significant increases in discussion rates in facilities with part-time or no NP/PA staffing (26% vs. 51%, p < .001, and 13% vs. 41%, p < .001, respectively) and decreases in decisional conflict scores (-0.08 vs. -0.047, p = .008, and -0.30 vs. -0.68, p = .014, respectively). Sites with full-time NP/PA staffing had high baseline rates of discussions (41%). These findings suggest that the decision aid and full-time NP/PA staffing can enhance surrogate decision making in nursing homes.
authors.affiliation: Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Ersek
authors.forename: Justine S
authors.initials: JS
authors.lastname: Sefcik
authors.forename: Feng-Chang
authors.initials: FC
authors.lastname: Lin
authors.forename: Tae Joon
authors.initials: TJ
authors.lastname: Lee
authors.forename: Robin
authors.initials: R
authors.lastname: Gilliam
authors.forename: Laura C
authors.initials: LC
authors.lastname: Hanson
mesh_terms: D003661:Decision Support Techniques; D009722:Nurse Practitioners / Q000600:supply & distribution*; D009735:Nursing Homes / Q000458:organization & administration; D010561:Personnel Staffing and Scheduling; D010823:Physician Assistants / Q000600:supply & distribution*
keywords: advance practice nursing; decision making; dementia; nursing home; nutrition