title: Improving Decision making On Location of Care with the frail Elderly and their caregivers (the DOLCE study): study protocol for a cluster randomized controlled trial.
abstract: BACKGROUND
  One of the toughest decisions faced by elderly people is whether to stay at home or move to a care facility. This study seeks to evaluate the impact of training interprofessional home-care teams in shared decision making combined with a decision aid on the proportion of elderly people who report being active in the decision-making process regarding whether to stay at home or move to a care facility.
  
  
  METHODS
  We propose a multicenter cluster randomized trial conducted with home-care interprofessional teams in the Province of Quebec with 2 data collection phases: before and after the intervention. Units of randomization will be centers for primary healthcare and social services. We will enroll 16 of these and ask each to provide one home-care interprofessional team involved in decisions and care planning with eligible clients. Clients will be included if they i) are aged ≥65; ii) are receiving care from the participating home-care interprofessional team; iii) have faced the decision about staying at home or moving to a care facility in the past 3 to 6 months; iv) are able to read, understand and write French or English; and v) are able to give informed consent. If clients are unable to provide informed consent, their primary caregiver who was involved in the decision-making process will be eligible to participate. The intervention arm will receive training in shared decision making and use of a decision aid. The control arm will receive 'usual care'. The primary outcome of interest is the assumed role in the decision-making process as assessed in clients or caregivers with a modified version of the Control Preferences Scale. Multilevel modeling will be used to take the hierarchical structure of the data into account. The study has obtained full ethical approval. The trial will comply with CONSORT guidelines adapted for cluster randomized trials.
  
  
  CONCLUSIONS
  Home care is a rapidly growing sector and this study will lay the foundations of a national strategy to ensure that IP home-care teams provide the highest quality of care for seriously ill elderly people and support for their families.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT02244359 (registered 18 September 2014).
authors.affiliation: Research Centre of the CHU de Québec, St-François D'Assise Hospital, 10, rue de l'Espinay D6-735, Quebec City, G1L 3 L5, Canada. France.Legare@mfa.ulaval.ca.|Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, 1050, avenue de la Médecine, Quebec City, G1V 0A6, Canada. France.Legare@mfa.ulaval.ca.
authors.forename: France
authors.initials: F
authors.lastname: Légaré
authors.affiliation: Centre de santé et de services sociaux (CSSS) de la Vieille-Capitale, 880, rue Père-Marquette, Quebec City, G1M 2R9, Canada. nathalie.briere@csssvc.qc.ca.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Brière
authors.affiliation: Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, K1H 8 L6, Canada. Dawn.stacey@uottawa.ca.|School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, K1H 8 M5, Canada. Dawn.stacey@uottawa.ca.
authors.forename: Dawn
authors.initials: D
authors.lastname: Stacey
authors.affiliation: Caregivers' representative, Research Centre of the CHU de Québec, St-François D'Assise Hospital, 10, rue de l'Espinay, Quebec City, G1L 3 L5, Canada. Henriette_bourass@videotron.ca.
authors.forename: Henriette
authors.initials: H
authors.lastname: Bourassa
authors.affiliation: Research Centre of the CHU de Québec, St-François D'Assise Hospital, 10, rue de l'Espinay D6-735, Quebec City, G1L 3 L5, Canada. Sophie.Desroches@fsaa.ulaval.ca.|Department of Food Science and Nutrition, Université Laval, 2425 rue de l'agriculture, Quebec City, G1V 0A6, Canada. Sophie.Desroches@fsaa.ulaval.ca.
authors.forename: Sophie
authors.initials: S
authors.lastname: Desroches
authors.affiliation: Centre de santé et de services sociaux (CSSS) de la Vieille-Capitale, 880, rue Père-Marquette, Quebec City, G1M 2R9, Canada. Serge.Dumont@svs.ulaval.ca.|School of Social Work, Université Laval, 1030, av. des Sciences-Humaines, Quebec City, G1V 0A6, Canada. Serge.Dumont@svs.ulaval.ca.
authors.forename: Serge
authors.initials: S
authors.lastname: Dumont
authors.affiliation: Faculty of Nursing, University of Alberta, 11405 87 Avenue, Edmonton, T6G 1C9, Canada. kdfraser@ualberta.ca.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Fraser
authors.affiliation: Research Centre of the CHU de Québec, St-François D'Assise Hospital, 10, rue de l'Espinay D6-735, Quebec City, G1L 3 L5, Canada. Adriana.Freitas@crchudequebec.ulaval.ca.
authors.forename: Adriana
authors.initials: A
authors.lastname: Freitas
authors.affiliation: Faculty of Sciences and Engineering, Department of Mathematics and Statistics, Université Laval, 1045 rue de la médecine, Quebec City, G1V 0A6, Canada. Louis-Paul.Rivest@mat.ulaval.ca.
authors.forename: Louis-Paul
authors.initials: LP
authors.lastname: Rivest
authors.affiliation: Caregivers' representative, Research Centre of the CHU de Québec, St-François D'Assise Hospital, 10, rue de l'Espinay, Quebec City, G1L 3 L5, Canada. Liseroy47@videotron.ca.
authors.forename: Lise
authors.initials: L
authors.lastname: Roy
mesh_terms: D000368:Aged; D017028:Caregivers; D002985:Clinical Protocols; D003657:Decision Making; D016330:Frail Elderly; D006801:Humans; D017063:Outcome Assessment, Health Care; D018401:Sample Size