title: An interprofessional approach to shared decision making: an exploratory case study with family caregivers of one IP home care team.
abstract: BACKGROUND
  Within the context of an exploratory case study, the authors assessed the perceptions of family caregivers about the decision-making process regarding relocating their relative and about the applicability of an interprofessional approach to shared decision making (IP-SDM). They also assessed perceptions of health professionals and health managers about IP-SDM.
  
  
  METHODS
  From November 2010 to October 2011, we worked with one IP home care team dedicated to older adults (the case) from a large primary health care organization in Quebec City, Canada. We identified six of their clients who had faced a decision about whether to stay at home or move to a long-term care facility in the past year and interviewed their family caregivers. We explored the decision-making process they had experienced regarding relocating their relative and their perceptions about the applicability of IP-SDM in this context. Attitudes towards IP-SDM and potential barriers to this approach were explored using a focus group with the participating IP home care team, individual interviews with 8 managers and a survey of 272 health professionals from the primary care organization. A hybrid process of inductive and deductive thematic analysis was used and data were triangulated across all sources.
  
  
  RESULTS
  Family caregivers reported lack of agreement on the nature of the decision to be made, a disconnection between home care services and relatives' needs, and high cost of long-term care alternatives. Factors influencing their decision included their ability to provide care for their relative. While they felt somewhat supported by the IP home care team, they also felt pressured in the decision. Overall, they did not perceive they had been exposed to IP-SDM but agreed that it was applicable in this context. Results from the survey, focus group and interviews with health professionals and managers indicated they all had a favourable attitude towards IP-SDM but many barriers hampered its implementation in their practice.
  
  
  CONCLUSIONS
  The family caregivers in this study did not experience IP-SDM when relocating their relative. Added to results obtained with health professionals and managers, this highlights the need for an effective intervention targeting identified barriers to implementing IP-SDM in this context.
authors.affiliation: Research Centre of the Centre Hospitalier Universitaire de Québec, Hôpital Saint-François d'Assise, 10 de L'Espinay, Room D6-735, Quebec City G1L 3 L5, Canada. France.Legare@mfa.ulaval.ca.
authors.forename: France
authors.initials: F
authors.lastname: Légaré
authors.forename: Dawn
authors.initials: D
authors.lastname: Stacey
authors.forename: Nathalie
authors.initials: N
authors.lastname: Brière
authors.forename: Hubert
authors.initials: H
authors.lastname: Robitaille
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Lord
authors.forename: Sophie
authors.initials: S
authors.lastname: Desroches
authors.forename: Renée
authors.initials: R
authors.lastname: Drolet
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000592:standards; D003657:Decision Making; D005260:Female; D006699:Home Care Services / Q000592:standards; D006801:Humans; D007400:Interprofessional Relations; D008875:Middle Aged; D010348:Patient Care Team / Q000592:standards; D010358:Patient Participation / Q000379:methods*