Shared Decision Making to Improve Palliative Care in the Nursing Home Abstract Twenty-eight percent of Americans over the age of 65 die in a nursing home. Research has found the quality of care of end-of-life care in nursing homes to have many challenges. It has also been documented that family members, especially those living at a distance, want to be involved in the care of their resident and family support can be beneficial to residents. Family members' involvement in decision-making in the nursing home setting improves outcomes for residents with life-limiting illnesses. Shared decision-making is a process wherein a healthcare choice is jointly made by a healthcare provider and a resident or resident's proxy (14, 15), often a family member. This proposal seeks to facilitate SDM among family members, residents with life- limiting illnesses (who are not enrolled in hospice), and the nursing home care team. Our overall research question (RQ) asks: To what extent are outcomes for family member and residents with life limiting illnesses associated with SDM via web-conferencing in the nursing home? Our overall hypothesis (H) is that SDM among family members, residents (when possible), and skilled nursing home staff via web- conferencing will improve outcomes for family members and residents with life-limiting illnesses. We propose exploratory mixed methods randomized clinical trial pilot to test the effect of shared decision making using web-based conferencing on the depression and burden of family members and the pain of nursing home residents. We seek to translate our hospice experience with web-conferencing and shared decision making into the nursing home setting with geriatric residents appropriate for palliative care.
In keeping with NIH mission of promoting and improving the health of individuals, families, communities, and populations, this proposal tests an intervention to assess the effect of shared decision making via web conferencing for family members of residents with serious illness in long term care facilities.
