A multimethod analysis of shared decision-making in hospice interdisciplinary team meetings including family caregivers.
BACKGROUND
Much of the existing research on shared decision-making in hospice and palliative care focuses on the provider-patient dyad; little is known about shared decision-making that is inclusive of family members of patients with advanced disease.


OBJECTIVE
We sought to describe shared decision-making as it occurred in hospice interdisciplinary team meetings that included family caregivers as participants using video-conferencing technology.


METHODS
We conducted a multimethod study in which we used content and thematic analysis techniques to analyze video-recordings of hospice interdisciplinary team meetings (n = 100), individual interviews of family caregivers (n = 73) and hospice staff members (n = 78), and research field notes.


METHODS
Participants in the original studies from which data for this analysis were drawn were hospice family caregivers and staff members employed by one of five different community-based hospice agencies located in the Midwestern United States.


RESULTS
Shared decision-making occurred infrequently in hospice interdisciplinary team meetings that included family caregivers. Barriers to shared decision-making included time constraints, communication skill deficits, unaddressed emotional needs, staff absences, and unclear role expectations. The hospice philosophy of care, current trends in healthcare delivery, the interdisciplinary nature of hospice teams, and the designation of a team leader/facilitator supported shared decision-making.


CONCLUSIONS
The involvement of family caregivers in hospice interdisciplinary team meetings using video-conferencing technology creates a useful platform for shared decision-making; however, steps must be taken to transform family caregivers from meeting attendees to shared decision-makers.
Department of Family and Community Medicine, University of Missouri, Columbia, MO, USA.
Karla T
KT
Washington
Department of Family and Community Medicine, University of Missouri, Columbia, MO, USA oliverdr@missouri.edu.
Debra Parker
DP
Oliver
Department of Social Work, University of Nebraska at Kearney, Kearney, NE, USA.
L Ashley
LA
Gage
School of Social Work, The University of Alabama, Tuscaloosa, AL, USA.
David L
DL
Albright
Department of Biobehavioral Nursing & Health Systems, School of Nursing, University of Washington, Seattle, WA, USA.
George
G
Demiris
D000328:Adult; D017028:Caregivers / Q000523:psychology; D003657:Decision Making; D005190:Family / Q000523:psychology; D005260:Female; D017051:Hospice Care / Q000458:organization & administration*; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008875:Middle Aged; D010347:Patient Care Planning / Q000592:standards; D011368:Professional-Family Relations; D049269:Videoconferencing
Hospices; caregivers; decision-making; family; patient care team