title: Most appropriate placement for people with dementia: individual experts' vs. expert groups' decisions in eight European countries.
abstract: OBJECTIVE
  To investigate the extent of variability in individuals' and multidisciplinary groups' decisions about the most appropriate setting in which to support people with dementia in different European countries.
  
  
  BACKGROUND
  Professionals' views of appropriate care depend on care systems, cultural background and professional discipline. It is not known to what extent decisions made by individual experts and multidisciplinary groups coincide.
  
  
  METHODS
  A modified nominal group approach was employed in eight countries (Estonia, Finland, France, Germany, the Netherlands, Spain, Sweden and the UK) as part of the RightTimePlaceCare Project.
  
  
  METHODS
  Detailed vignettes about 14 typical case types of people with dementia were presented to experts in dementia care (n = 161) during November and December 2012. First, experts recorded their personal judgements about the most appropriate settings (home care, assisted living, care home, nursing home) in which to support each of the depicted individuals. Second, participants worked in small groups to reach joint decisions for the same vignettes.
  
  
  RESULTS
  Considerable variation was seen in individuals' recommendations for more than half the case types. Cognitive impairment, functional dependency, living situation and caregiver burden did not differentiate between case types generating high and low degrees of consensus. Group-based decisions were more consistent, but country-specific patterns remained.
  
  
  CONCLUSIONS
  A multidisciplinary approach would standardize the decisions made about the care needed by people with dementia on the cusp of care home admission. The results suggest that certain individuals could be appropriately diverted from care home entry if suitable community services were available.
authors.affiliation: Department of Internal Medicine, University of Tartu, Estonia.
authors.forename: Kai
authors.initials: K
authors.lastname: Saks
authors.affiliation: University of Tartu, Estonia.
authors.forename: Ene-Margit
authors.initials: EM
authors.lastname: Tiit
authors.affiliation: CAPHRI School for Public Health and Primary Care, Maastricht University, The Netherlands.
authors.forename: Hilde
authors.initials: H
authors.lastname: Verbeek
authors.affiliation: Regionaalhaigla, Palliative Care Service, Tallinn, Estonia.
authors.forename: Katrin
authors.initials: K
authors.lastname: Raamat
authors.affiliation: Foundation of Mental Health Care Centre, Tartu, Estonia.
authors.forename: Angelika
authors.initials: A
authors.lastname: Armolik
authors.affiliation: Tallinn Diaconal Hospital of the Estonian Evangelical Lutheran Church, Estonia.
authors.forename: Jelena
authors.initials: J
authors.lastname: Leibur
authors.affiliation: Medical Faculty, Institute for Health and Nursing Science, Martin-Luther-University Halle-Wittenberg, Germany.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Meyer
authors.affiliation: Hospital Clinic of Barcelona, Spain.
authors.forename: Adelaida
authors.initials: A
authors.lastname: Zabalegui
authors.affiliation: Department of Nursing Science, University of Turku, Finland.
authors.forename: Helena
authors.initials: H
authors.lastname: Leino-Kilpi
authors.affiliation: Department of Health Sciences, Lund University, Sweden.
authors.forename: Staffan
authors.initials: S
authors.lastname: Karlsson
authors.affiliation: Geriatrics Department, Gerontopole, Toulouse University Hospital, France.
authors.forename: Maria
authors.initials: M
authors.lastname: Soto
authors.affiliation: Personal Social Services Research Unit, University of Manchester, UK.
authors.forename: Sue
authors.initials: S
authors.lastname: Tucker
mesh_terms: D000368:Aged; D003657:Decision Making; D003704:Dementia / Q000451:nursing / Q000628:therapy*; D005060:Europe; D006126:Group Processes; D006801:Humans
keywords: care setting; decision-making; dementia; multidisciplinary team; needs assessment in nursing