Introduction Patients with complex care needs (PCCNs) often suffer from combinations of multiple chronic conditions, mental health problems, drug interactions and social vulnerability, which can lead to healthcare services overuse, underuse or misuse. Typically, PCCNs face interactional issues and unmet decisional needs regarding possible options in a cascade of interrelated decisions involving different stakeholders (themselves, their families, their caregivers, their healthcare practitioners). Gaps in knowledge, values clarification and social support in situations where options need to be deliberated hamper effective decision support interventions. This review aims to (1) assess decisional needs of PCCNs from the perspective of stakeholders, (2) build a taxonomy of these decisional needs and (3) prioritise decisional needs with knowledge users (clinicians, patients and managers). Methods and analysis This review will be based on the interprofessional shared decision making (IP-SDM) model and the Ottawa Decision Support Framework. Applying a participatory research approach, we will identify potentially relevant studies through a comprehensive literature search; select relevant ones using eligibility criteria inspired from our previous scoping review on PCCNs; appraise quality using the Mixed Methods Appraisal Tool; conduct a three-step synthesis (sequential exploratory mixed methods design) to build taxonomy of key decisional needs; and integrate these results with those of a parallel PCCNs' qualitative decisional need assessment (semistructured interviews and focus group with stakeholders).
Bibliographical noteFunding Information:
1Department of Family Medicine, McGill University, Montréal, Québec, Canada 2Department of Family Medicine and Emergency Medicine, Université Laval, Montréal, Québec, Canada 3McGill Library, McGill University, Montréal, Québec, Canada 4Department of Family Medicine, Université de Sherbrooke, Canada 5Family and Emergency Medicine, Université de Montréal, Canada 6École de travail social, Université de Sherbrooke, Canada 7Beatitude Patient engagement in research, Sherbrooke, Canada 8Jewish General Hospital, Montréal, Québec, Canada 9Faculty of Pharmacy, Université Laval, Montréal, Québec, Canada 10Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, United States 11Centre de Science Politique et de Politique Comparée, Université catholique de Louvain, Belgium 12Université de Lausanne, Switzerland 13Japan National Center for Geriatrics & Gerontology, Obu, Japan 14Université d'Aix-Marseille, France 15Heidelberg University Hospital, Germany Acknowledgements The preparation of this protocol was supported by the Quebec SPOR SUPPORT Unit. Pierre Pluye holds a salary award from the Fonds de recherche du Québec – Santé (FRQS). Authors gratefully acknowledge and the following collaborators: Magali Bigras and Alain Boulet, Centre de santé et de services sociaux de Gatineau, Canada ; Lynn R. McLauchlin, St. Mary's Hospital Center, Montreal, Canada; Silvia Duong, Jewish General Hospital, Montreal, Canada; and Fanny Hersson, Department of Family Medicine, McGill University, Canada).
The taxonomy will be compared and integrated with the results of a parallel qualitative decisional need assessment of PCCNs that is part of the provincial ‘Demonstration project’ of the Quebec SPOR SUPPORT Unit funded by Canadian Institutes of Health Research (CIHR), Quebec Ministry of Health and the Fonds de recherche du Québec – Santé (FRQS). In this parallel qualitative study, conducted by coauthors of this review, semistructured interviews and focus group will be done with patients/ relatives, health and social primary care practitioners and decision makers to empirically assess decisional needs of PCCNs. This qualitative study will involve four expert patients, including one who is participating in all stages of the systematic review. The qualitative decisional need assessment and this systematic review will be done concurrently to validate emerging decisional needs. This will give a deeper and broader understanding to better inform the subsequent user-centred design of an IP-SDM support tool.
Funding This work is funded by the Canadian Institutes for Health Research (CIHR) grant number 201630KRS-367087. CIHR had no role in the development of this protocol.
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- interprofessional care
- patients with complex care needs
- primary care
- shared decision making