title: Shared decision-making in dementia care planning: barriers and facilitators in two European countries.
abstract: Shared decision-making (SDM) is a means of allowing people with dementia to take part in making choices, be autonomous and participate in social activities. Involving them in SDM is an important way of promoting social health. However, including families and dementia residents in decision-making can be challenging for care staff working in nursing homes. The objective of this study was to identify barriers and facilitators regarding the implementation of an SDM framework for care planning in two nursing homes, one in Italy and one in the Netherlands.
  
  
  
  Focus group interviews were conducted with healthcare professionals who, after being trained, applied the SDM framework. Content analysis was used to analyze the data.
  
  
  
  Six months after the feasibility trial, focus group interviews with healthcare professionals (n = 10 in Italy; n = 9 in the Netherlands) were held. We found 6 themes and 15 categories. Within these themes, facilitators and barriers were identified. The categories of team collaboration, communication skills and nursing home policy were found to be facilitators to the implementation process, whereas regulations, lack of funding and of involvement of family caregivers were the main barriers. Family attitudes towards SDM could be both. The main difference between countries concerned the residents' cognitive status that influenced their degree of involvement.
  
  
  
  Communication skills training for professionals, training of family caregivers, and involvement of the management in the implementation process seem to be crucial factors in successfully implementing SDM in nursing homes, and increasing the involvement of families and dementia residents in decision-making.
authors.affiliation: a Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Centre , Nijmegen , The Netherlands.|b Department of Psychology, Alma Mater Studiorum , University of Bologna , Bologna , Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Mariani
authors.affiliation: a Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Centre , Nijmegen , The Netherlands.|c Kalorama Foundation , Beek-Ubbergen , The Netherlands.|d Radboud Alzheimer Center.
authors.forename: Myrra
authors.initials: M
authors.lastname: Vernooij-Dassen
authors.affiliation: d Radboud Alzheimer Center.|e Department of Primary and Community Care , Radboud University Medical Centre , Nijmegen , The Netherlands.|f Joachim & Anna, Center for Specialized Geriatric Care , Nijmegen , The Netherlands.
authors.forename: Raymond
authors.initials: R
authors.lastname: Koopmans
authors.affiliation: g Department of Anaesthesiology, Pain and Palliative Medicine , Radboud University Medical Centre , Nijmegen , The Netherlands.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Engels
authors.affiliation: b Department of Psychology, Alma Mater Studiorum , University of Bologna , Bologna , Italy.
authors.forename: Rabih
authors.initials: R
authors.lastname: Chattat
mesh_terms: D000328:Adult; D000368:Aged; D017028:Caregivers / Q000523:psychology; D003657:Decision Making; D003704:Dementia / Q000523:psychology / Q000628:therapy*; D005260:Female; D017144:Focus Groups; D006282:Health Personnel / Q000523:psychology; D006707:Homes for the Aged / Q000458:organization & administration; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009735:Nursing Homes / Q000458:organization & administration*; D018802:Patient-Centered Care / Q000458:organization & administration*; D036301:Qualitative Research; D058996:Quality Improvement / Q000458:organization & administration*; D055815:Young Adult
keywords: Dementia; family; nursing homes; shared decision-making; staff