Objectives Decision aids are effective to improve decision-making yet they are

Objectives Decision aids are effective to improve decision-making yet they are rarely tested in nursing homes (NHs). care plan meeting between the SDM and interdisciplinary NH team Measurements Surrogate knowledge quality of communication with health care providers surrogate-provider concordance on goals of care and palliative care domains addressed in the care plan. Results 89 of the SDMs thought the decision aid was relevant to their needs. After looking at the video decision aid SDMs increased the number of right reactions on knowledge-based questions (12.5 vs 14.2 P<.001). At 3 months they reported improved quality of communication scores (6.1 vs 6.8 P=.01) and improved concordance on primary goal of care with nursing home team (50% vs 78% P=.003). The number of palliative care and attention domains addressed in the care and attention plan improved (1.8 vs 4.3 P<.001). Summary The decision-support treatment piloted with this study was feasible and relevant for surrogate decision-makers Zosuquidar of individuals with advanced dementia in nursing homes and it improved quality of communication between SDM and NH companies. A larger randomized medical trial is definitely underway to provide further evidence of the effects of this decision aid treatment. family comments emotions the patient like a person and family questions) to discuss goals of care. 33 Staff viewed the video and received a copy of the imprinted information given to surrogates. Zosuquidar Actions Data collection consisted of surrogate interviews and resident chart evaluations at baseline and at 3- month follow-up. Baseline interviews lasted 90 moments and were carried out in-person when possible unless the surrogate lived out of the area. All follow-up interviews were conducted over the telephone and lasted about 45 moments. To establish feasibility and relevance of the decision aid treatment investigators collected data on fidelity to the treatment and surrogates’ understanding of its relevance. Fidelity was defined as percent adherence to each of the following items in the care plan meeting: 1) presence of the surrogate decision-maker 2 presence of primary health care provider 3 conversation of goals of care 4 selection of primary goal and 5) formation of treatment plan. Open-ended questions during interviews with surrogates were used to assess Zosuquidar the perceived relevance ease of use and helpfulness of the treatment. To understand the effect of the decision aid treatment on quality of communication main outcomes were a) surrogate knowledge b) quality of communication c) surrogate-provider concordance and d) number of palliative care and attention domains addressed in the care and attention plan. Surrogate knowledge was assessed during the baseline interview with 18 true/false items concerning dementia goals of care and treatment options. These items were asked before and after looking at the decision aid in the baseline interview. Quality of communication with nursing home providers was measured at baseline and 3-month follow-up interviews using the Quality of Communication (QOC) instrument.34 35 The QOC consists of 13 items rated on a 10-point scale; items form two subscales measuring general (Cronbach’s alpha=0.91) and end-of-life communication (Cronbach’s alpha=0.79). Surrogate-provider concordance on Goals of Care was defined as the percent of family surrogates who statement that their primary Zosuquidar goal and the primary goal of the nursing home staff are the same. Surrogates were first asked to choose what the resident would say is the most practical goal of care as a measure of their primary goal. Next surrogates were VCL asked “Based on your discussions with the nursing home providers what you believe is the current goal used to guide [resident’s] treatment right now?” This item was used to define the nursing home team’s goal and was asked during interviews at baseline and at 3-month follow-up. The number of palliative care and attention domains tackled in care and attention plans was measured in baseline and follow-up chart reviews. Investigators wanted care information on 10 domains of palliative care. Each website was obtained as present or absent for any potential score from 0-10. Included domains were prognosis goals of care plan to assess and treat physical symptoms plan to assess and fulfill emotional needs plan to assess and fulfill spiritual demands and preferences for use of 5 treatments: resuscitation artificial feeding.