What personal support workers need to support older adults in making informed and shared decisions within home care teams
Bibliographic record
Abstract
Background: Personal support workers (PSWs) are the largest group of home care providers who can play a pivotal role in helping their vulnerable older clients in making informed and shared decisions together with their home care teams. Shared decision making refers to a process whereby individuals and their care teams make health care choices together.[] Despite the many benefits of shared decision making (SDM), vulnerable older adults in the home care setting have been reported as less likely to experience SDM when faced with health and social care decisions.[2] Approach: We report on a qualitative analysis of textual data collected from a web-based survey of home care providers.[3] Our focus on analyzing data from PSWs is aimed at informing what PSWs need to support vulnerable older adults in making informed and shared decisions within home care teams. This study is part of a broader research program on what older adults, caregivers and interdisciplinary care team members need to support shared decision making.[4,5] Participants were recruited from a Canadian home care organization, SE Health. Participants were offered an opportunity to enter a draw for a $20 gift card. A participatory advisory group of one older adult, one caregiver and two care providers guided the research process (including study protocol review, survey development, data collection and analysis process). Training was provided as required to support their active participation as part of the research team. Ethics approval was obtained from the University of Laval, Quebec, and Southlake Regional Health Center, Ontario. Results: Our participants (personal support workers) were predominantly represented by older women with extensive home care experience (n=372, female = 92%, over 40 years of age = 67%, over 0 years of home care experience = 40%). Staying within their scope of practice our participants did not always perceive their distinct role in supporting vulnerable older adults with making decisions. Yet, as the trusted care provider whom vulnerable older adults rely on for support, they perceive themselves as understanding the personal situations of their clients. Situational challenges (such as the expectation to follow care plans as determined by nurse supervisors/case managers) may limit their ability to fully participate as care team members to voice the perspectives of their clients. Implications: Although front-line PSWs might best understand the situation of their clients, situational challenges can limit their ability to fully participate on care teams and voice the perspective of their older clients. Our study highlights the need for further research on the role of personal support workers in supporting shared decision making within care teams. References: Charles C, et al. Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Soc Sci Med997 DOI: https://doi.org/0.06/s0277-9536(96)0022-32) Haesebaert, J., Adekpedjou, R., Croteau, J., Robitaille, H., Legare, F. (209) Shared decision-making experienced by Canadians facing health care decisions: a Web-based survey. CMAJ Open 7(2) DOI: https://doi.org/0.9778/cmajo.20802023) Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005 Nov;5(9):277-88. DOI: https://doi.org/0.77/0497323052766874) Lai C, Holyoke P, Plourde KV, D cary S, LgarF. What older adults and their caregivers need for making better health-related decisions at home: a participatory mixed methods protocol. BMJ open. 2020 Nov ;0():e03902. DOI: https://doi.org/0.36/bmjopen-2020-039025) Lai C, Holyoke P, Plourde KV, Yeung L, LgarF. Home care providers' perceptions of shared decision‐making with older clients (and their caregivers): A cross‐sectional study. Nursing Health Sciences. 2022 Jun;24(2):487-98. DOI: https://doi.org/0./nhs.2946
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.012 | 0.043 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.007 | 0.003 |
| Scholarly communication | 0.007 | 0.009 |
| Open science | 0.002 | 0.005 |
| Research integrity | 0.003 | 0.004 |
| Insufficient payload (model declined to judge) | 0.006 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".