The COVID-19 pandemic wreaked havoc on long-term care in Canada. During the first two waves in 2020, more than 80 per cent of all Canadian COVID-19 deaths happened in long-term care homes. While vaccination and policy changes have helped to reduce the number of deaths, long-term care homes are still experiencing COVID-19 outbreaks and severe staffing shortages.
The purpose of this survey is to collect information about ableism and barriers to accessibility at CIHR, and in the broader health research funding system. We will summarize survey answers and use the information to co-develop an action plan with the CIHR External Advisory Committee on Accessibility and Systemic Ableism.
If you have a disability or health condition that affects how you interact with the health research funding system, or you have helped someone navigate ableism and barriers to accessibility in the health research funding system, we would like to learn from you. We welcome the following groups of people to complete the survey:
-Health researchers with disabilities
-Health research trainees with disabilities
-Undergraduate and graduate students with disabilities enrolled in health-oriented programs
-Individuals who have a health condition that affects how they interact with the health research funding system
-Users or holders of knowledge related to health research
-Experienced allies of people with disabilities.
Supporting older adults to age in their own homes and/or communities for as long as possible, commonly referred to as “ageing in place,” can help Canada’s already-strained LTC systems. Yet doing so effectively also requires responsive systems and services that can enable what the NIA calls “Ageing in the Right Place.” Recognizing the growing importance of supporting older Canadians’ ability to age successfully while remaining engaged members of their communities, this report aims to present a practical definition and framework to understand what ageing in the right place (AIRP) is and what is required to make it work. It also highlights existing best practices and opportunities that can reduce unnecessary LTC home admissions and better support the implementation of successful AIRP policies and programs across Canada and beyond.
This report seeks to bring together what is currently known about ageing and health, and to outline a public-health framework for action relevant to countries at all levels of development. Thus, the report can be considered to be giving substance to the health priorities identified more than 10 years ago by the Political declaration and Madrid international plan of action on ageing and Active ageing: a policy framework. However, given the significance of this task, the lack of action to date and the need to stimulate a global public-health response, we suggest a twin-track approach to policy that emphasizes the need for both healthy and active ageing. This emphasis is consistent with recent initiatives undertaken within the European Union (29). Because the determinants of health in older age are being established even before we are born, this report applies a life-course approach (30, 31), but the focus of the report is on the second half of life
The OHDC supports ongoing efforts to transform the health system by advising on how health data can improve health outcomes while safeguarding patient privacy.
The OHDC report outlines current challenges for the collection, sharing, use and disclosure of health data, along with a vision for health data and health data governance. Convening the Council has been part of an ongoing commitment to the use of health data for the benefit of all Ontarians.
Zimmerman S, Sloane PD, Rashik MI.
Journal of the American Medical Directors Association. 2022 Nov 1;23(11):1755–6.
Terminology evolves with the times, and rightly so. In the not-too-distant past, terms weren’t needed to “take a selfie, write a blog, purchase a wearable, eat an edible, insert an emoji, be a foodie, have a staycation, develop a podcast, avoid spam” or “Google it.” Terms also evolve to recognize the worth and importance of a given job and to avoid discrimination. Garbage men have become sanitation workers, housewives are homemakers, stewards and stewardesses are flight attendants.
Arén C, Jaçelli A, Gesar B, From I.
BMC Nurs. 2022 Nov 2;21(1):296.
BACKGROUND: Stress can originate from many different unsatisfying work situations. Registered nurses working in municipal care have experience of work-related stress in different ways. AIM: The purpose of this study was to describe the work-related stress experienced by registered nurses caring for older people at municipal aged care facilities. METHODS: Qualitative semi-structured interviews according to Polit and Beck were carried out in clinical work at six different municipal aged care facilities in Sweden. Twelve registered nurses participated in the study. RESULTS: The results outlined in one main central theme: Feelings of inadequacy and dissatisfaction contribute to work-related stress and three categories: Difficulty coping with work tasks, Insufficient support, Work-related stress affects private lives. Areas identified were lack of time, staff shortages, high number of patients, lack of communication and teamwork in the working group, showing that inadequacy and dissatisfaction can contribute to work-related stress. This can contribute to work-related stress, and it can be a result of problems in the organizational and social work environment. CONCLUSION: This study showed the everyday experiences of registered nurses’ stress at work. The reasons that registered nurses experience a heavy workload were found to be similar in several municipal care facilities. Future interventions should consider the areas of stress found in this study to reduce the risk of further increasing the work-related stress experienced by registered nurses working in municipal aged care.
Chen H, Cao Y, Lu Y, Zheng X, Kong B, Dong H, et al.
Front Psychiatry. 2022;13:1011775.
BACKGROUND: COVID-19 pandemic has altered the work mode in long-term care facilities (LTCFs), but little is known about the mental health status of caregivers of older adults. METHODS: A total of 672 formal caregivers of older adults in LTCFs and 1,140 formal patient caregivers in hospitals (comparison group) responded to an online survey conducted from March 25, 2022 to April 6, 2022. Five psychological scales, including Insomnia Severity Index (ISI), Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), The 5-item World Health Organization Wellbeing Index (WHO-5) and Perceived Stress Scale-14 item (PSS-14), were applied to assess participants’ mental health status. Factors, including sex, profession, marital status, economic conditions, length of working experience, frequent night shift beyond 1 day per week and having organic diseases, were included in logistic regression analysis to identify associated factors with mental health outcomes of formal caregivers of older adults in LTCFs. RESULTS: Caregivers of older adults in LTCFs developed similar severe psychological symptoms with patient caregivers in hospital setting. For caregivers of older adults in LTCFs, unmarried status was a potent risk factor for insomnia, anxiety, impaired wellbeing and health risk stress, with odds ratios ranging from 1.91 to 3.64. Frequent night shift beyond 1 day per week was associated with higher risks of insomnia, depression and impaired wellbeing. Likewise, having organic disease or inferior economic condition, and being nurses appeared to be independent predictors for multiple mental health-related outcomes. CONCLUSION: During COVID-19 post-epidemic era, caregivers of older adults in LTCFs had a higher prevalence of psychological symptoms, especially those with particular risk factors. Special attention should be paid to promote their mental health.
Kang YJ, Monsen KA, Jeppesen B, Hanson C, Nichols K, O’Neill K, et al.
Interdiscip J Partnersh Stud. 2022 May 24;9(1):7.
Nursing home experts and informatics nurses collaborated to develop guidelines for nursing homes that revealed partnership principles in action during the COVID-19 pandemic. This article describes efforts to define interprofessional nursing home staff roles within the partnership-based COVID-19 Response Guideline, and to examine changes in nursing practice compared to the pre-pandemic practice of nurses. The qualitative process of identification of nursing home staff roles revealed the extensive scope of interprofessional partnership needed to respond to the pandemic. Using the Omaha System structure, we compared these collective COVID-19 response interventions of Nursing Service roles with nursing interventions of RNs and LPN/LVNs defined in previous nursing home studies. This comparison showed the necessary transformation and collaboration among nurses needed for the pandemic response in nursing homes. The Omaha System Pandemic Guideline is available online and in the Omaha System Guidelines app for immediate use as COVID-19 response practice guidelines and references for interprofessional roles in nursing homes, as well as for multidisciplinary roles across diverse care settings. The guideline is an exemplar of how informatics can facilitate interprofessional and multidisciplinary partnership for nursing homes and other care settings. Future use of the guidelines for decision making and documentation related to infection prevention and control in nursing homes may improve care quality and health outcomes of residents and population.
Schneider J, Tsoukalas T, Zulla R, Nicholas D, Hewson J.
J Gerontol Soc Work. 2022 Oct 25;1–13.
The COVID-19 pandemic ushered in multiple public health protocols that shaped the service delivery system supporting older adults, their family caregivers and their formal care providers. In this qualitative study, sixteen social workers employed in long term care facilities in a western province of Canada shared their perspectives about the impacts of the COVID-19 pandemic on their practice early in the pandemic. Participants responded to nine open-ended online survey questions about their practice and experiences. Four themes were identified: (1) a changing and demanding work environment, (2) witnessing transitions in residents’ quality of life, (3) impacts on relationships and work climate, and (4) personal impacts on social workers. Recommendations for enhancing capacity in the system were identified. Implications of findings illuminate a need for proactive preparedness approaches in order for social workers to address emergent and changing needs of residents and their families during a pandemic.
Zhang H, Wu Y, Wang N, Sun X, Wang Y, Zhang Y.
J Nurs Manag. 2022 Oct 8.
AIMS: The goal of this study was to explore caregivers’ experiences, perspectives, emotions, knowledge and needs in caring for older people during the COVID-19 pandemic. These included, but were not limited to, experiences in hospital care, home care and nursing home care. BACKGROUND: Because of the high mortality rate associated with the COVID-19 pandemic, senior care is critical. During the COVID-19 pandemic, caregivers caring for older people have had unique experiences potentially affecting the quality of care provided. This topic has received substantial attention since the start of the pandemic and has been studied by numerous researchers. However, experiences may differ among countries and time periods. In addition, no qualitative systematic reviews on this topic appear to have been published. EVALUATION: In this systematic review of qualitative studies, data were collected from the following electronic databases: PubMed, Web of Science, Scopus, CINAHL, Science Direct and PsycINFO. Titles and abstracts were screened according to the inclusion and exclusion criteria, full texts were screened and the methodological quality of included studies was assessed with the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research by two independent reviewers. KEY ISSUE(S): A total of 141 findings were extracted and aggregated into 20 categories; six synthesized findings were identified. CONCLUSION: This review indicates caregivers’ experiences and perceptions regarding caring for older people during the COVID-19 pandemic. The results of a qualitative systematic review show that caregivers’ emotions, cognitions and knowledge have affected the quality of caregivers’ senior care services during the pandemic. Caregivers caring for older adults should practice self-awareness, understanding their knowledge and attitudes to improve the quality of senior care. Moreover, healthcare administrators and policymakers should make concerted efforts to cultivate a better working environment. IMPLICATIONS FOR NURSING MANAGEMENT: Managers should formulate timely and effective management strategies. During the COVID-19 pandemic, the workload of caregivers has increased, thus requiring better scheduling by managers. Furthermore, managers should consider the negative emotions of caregivers and prevent negative emotions from affecting their work. Besides, virtual technology should be applied to senior care and psychological support be provided for caregivers in this special care setting.
Burns P, Currie G, McLoughlin I, Robinson T, Sohal A, Teede H.
BMC Health Serv Res. 2022 Oct 29;22(1):1303.
BACKGROUND: Process improvement in healthcare is informed by knowledge from the private sector. Skilled individuals may aid the adoption of this knowledge by frontline care delivery workers through knowledge brokering. However, the effectiveness of those who broker knowledge is limited when the context they work within proves unreceptive to their efforts. We therefore need greater insight into the contextual conditions that support individuals to broker process improvement knowledge to the frontline of care delivery, and how policy makers and organizations might generate such conditions. METHODS: Our research took place in a healthcare system within an Australian State. We undertook a qualitative, embedded single case study over the four year period of a process improvement intervention encompassing 57 semi-structured interviews (with knowledge brokers, policy makers, and executive sponsors), 12 focus groups, and 137 h of observation, which included the frontline implementation of actual process improvement initiatives, where knowledge brokering took place. RESULTS: We identified four phases of the process improvement intervention that moved towards a more mature collaboration within which knowledge brokering by improvement advisors began to emerge as effective. In the first phase knowledge brokering was not established. In the second phase, whilst knowledge brokering had been initiated, the knowledge being brokered lacked legitimacy amongst frontline practitioners, resulting in resistance. Only in the fourth and final phase of the intervention did the collective experience of policy makers result in reflections on how they might engender a more receptive context for knowledge brokering. CONCLUSION: We highlight a number of suggested actions that policy makers might consider, if they wish to engender contextual conditions that support knowledge brokering. Policy makers might consider: ensuring they respect local context and experience, by pulling good ideas upward, rather than imposing foreign knowledge from on high; facilitating the lateral diffusion of knowledge by building cultural linkages between people and organizations; strengthening collaboration, not competition, so that trans-organisational flow of ideas might be encouraged; being friend, not foe, to healthcare organizations on their knowledge integration journey. In sum, we suggest that top-down approaches to facilitating the diffusion and adoption of new ideas ought to be reconsidered.
Haring M, Freigang F, Amelung V, Gersch M.
BMC Health Serv Res. 2022 Oct 28;22(1):1299.
BACKGROUND: Until now, scholarship on innovation processes in healthcare systems lack an in-depth appreciation of tensions. Tensions often revolve around barriers and result from individual assessments and prioritizations that guide actions to eventually overcome these barriers. In order to develop a more differentiated understanding of tensions’ role in healthcare innovation processes, this paper aims to shed light on the multifaceted ways in which tensions emerge, are being dealt with, and how they hinder or, at times, facilitate innovation processes. METHODS: A systematic review of published and grey literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline. The review involved searching three databases for original research articles and manually searching citations. Twenty-nine original full texts were identified, evaluated, and coded. These include papers on innovation in healthcare systems that investigated innovation-related organizational tensions. The findings were synthesized into different types of tensions in healthcare system innovation and the descriptions of the conflicting elements. We also analyzed the investigated innovations by type, process stages, and across different countries and healthcare systems. RESULTS: A total of forty-two tensions were identified and grouped into nine categories. Organizing tensions were predominant, followed by learning/belonging, performing, and performing/organizing tensions. Tensions most frequently occurred in the implementation phase and in the form of a dilemma. Included studies were conducted mainly in government-funded healthcare systems. CONCLUSION: Our data suggest that innovation processes in healthcare systems are impaired by conflicts between contradictory elements, working cultures, and convictions and the organizational and regulatory context. Since the majority of the tensions we collected in our study can be addressed, future policy-making and research should take advantage of this fact and develop strategies that significantly influence the successful management of tensions and thus improve the implementation of innovations.
Kay S, Unroe KT, Lieb KM, Kaehr EW, Blackburn J, Stump TE, et al.
J Appl Gerontol. 2022 Oct 7;7334648221131469.
BACKGROUND: Incomplete communication between staff and providers may cause adverse outcomes for nursing home residents. The Situation-Background-Assessment-Recommendation (SBAR) tool is designed to improve communication around changes in condition (CIC). An adapted SBAR was developed for the Centers for Medicare and Medicaid Services demonstration project, OPTIMISTIC, to increase its use during a resident CIC and to improve documentation. METHODS: Four Plan-Do-Study-Act (PDSA) cycles to develop and refine successive protocol implementation of the OPTIMISTIC SBAR were deployed in four Indiana nursing homes. Use of SBAR, documentation quality, and participant surveys were assessed pre- and post-intervention implementation. RESULTS: OPTIMISTIC SBAR use and documentation quality improved in three of the four buildings. Participants reported improved collaboration between nurses and providers after SBAR intervention. CONCLUSION: Successive PDSA cycles implementing changes in an OPTIMISTIC SBAR protocol for resident CIC led to an increase in SBAR use, improved documentation, and better collaboration between nursing staff and providers.
Potrebny T, Igland J, Espehaug B, Ciliska D, Graverholt B.
BMC Health Serv Res. 2022 Oct 10;22(1):1244.
BACKGROUND: The organizational context in healthcare (i.e., the work environment) is associated with patient outcomes and job satisfaction. Long-term care is often considered to be a challenging work environment, characterized by high job demands, low job control, a fast work pace and job dissatisfaction, which may affect patient care and increase staff turnover.This study aims to investigate the organizational context in nursing homes and the features of favorable or less favorable work environments. METHODS: This study is a cross-sectional study of registered nurses and licensed practical nurses in Bergen, Norway (n = 1014). The K-means clustering algorithm was used to differentiate between favorable and less favorable work environments, based on the Alberta Context Tool. Multilevel logistic regression analysis was used to investigate the associations between individual sociodemographic factors, nursing home factors and the probability of experiencing a favorable work environment. RESULTS: 45% of the sample (n = 453) experienced working in a favorable work environment. Contextual features (especially a supportive work culture, more evaluation mechanisms and greater organizational slack resources) and individual features (having a native language other than Norwegian, working day shifts, working full time and belonging to a younger age group) significantly increased the likelihood of experiencing a favorable work environment. CONCLUSION: The work environment in nursing homes is composed of modifiable contextual features. Action in relation to less favorable features and their associated factors should be a priority for nursing home management. This survey indicates that specific steps can be taken to reduce the reliance on part-time workers and to promote the work environment among staff working the night shift.
Roland D, Allan S, Chambers E, Smith D, Gousia K.
Front Public Health. 2022;10:970370.
Personal assistants (PAs) have become an increasingly important element of long-term care (LTC) in England since the introduction of Direct Payments in 1996 and the Care Act 2014 legislation. The PAs, who are directly employed by social care users, can perform a number of support tasks including vital assistance in activities of daily living (ADL). Internationally these roles would be classed as domestic care work, including the employment of migrant care workers, e.g. in Germany and Austria. High turnover rates and work absenteeism in this market can cause disruption of these important daily activities, causing LTC users to potentially suffer neglect and poorer quality of life. Although there is research on turnover and absenteeism in nursing workforce in hospitals and LTC workers in nursing homes, little attention has been given to reasons for turnover of PAs and even less for absenteeism, which often precedes turnover, in a workforce of over 100,000 people in England. This research aims to fill this gap in knowledge by analyzing the reasons behind the absenteeism of PAs using quantitative methods. We used survey data of PAs in England, exploring the factors associated to one form of absenteeism-sick leave from work. After controlling for a number of factors ranging from job characteristics such as number of hours worked and type of contract, socio-economic characteristics from the PA and their employer, and supply and demand factors at local government region, the findings suggest a number of factors that significantly influenced sick leave, including distances traveled to work and number of PAs employed. Following the analysis, two people with life experience of LTC discuss the findings of the study and how they compare to their experiences of the market for PAs, providing a unique perspective from the people who could benefit the most from improving PA retention and reducing absenteeism.
Rosen A, Cahill JM, Dugdale LS.
J Gen Intern Med. 2022 Nov;37(14):3739–43.
Frontline health-care workers experienced moral injury long before COVID-19, but the pandemic highlighted how pervasive and damaging this psychological harm can be. Moral injury occurs when individuals violate or witness violations of deeply held values and beliefs. We argue that a continuum exists between moral distress, moral injury, and burnout. Distinguishing these experiences highlights opportunities for intervention and moral repair, and may thwart progression to burnout.
Schoultz M, McGrogan C, Beattie M, Macaden L, Carolan C, Dickens GL.
PLoS One. 2022;17(11):e0277062.
AIMS: Psychological First Aid is a brief intervention based on international guidance from the World Health Organisation. Free to access online training in the intervention was introduced during the COVID-19 pandemic in UK. We aimed to determine the uptake of Psychological First Aid training among healthcare workers in care homes in the UK and to assess its effects on their wellbeing. DESIGN: This was a sequential mixed methods design. METHODS: Healthcare workers (nurses and carers) working in care homes in the UK were surveyed about their uptake of Psychological First Aid, their stress, coping efficacy and the key concepts of Psychological First Aid (safety, calmness, hopefulness, connectedness, and accomplishment). Those that completed the Psychological First Aid training were asked to share their experiences via qualitative survey. Data collection was conducted between June and October 2021. Analyses included descriptive statistics and regression analysis. A six step thematic analysis was used to interpret the qualitative data. RESULTS: 388 participants responded to the survey. The uptake of Psychological First Aid training was 37 (9.5%). Psychological first aid was a significant predictor for coping efficacy (β = 17.54, p = .001). Participants with a physical or mental health condition experienced higher stress and lower coping regardless of PFA training. Four themes were identified from the qualitative analysis: self-awareness and growth, relationships with others, overcoming stress and accessibility. CONCLUSION: While this study suggests some benefits to healthcare workers in care home settings undergoing PFA the poor uptake of the training warrants further investigation. IMPACT: Care home staff need psychological support. This gap remains as few completed PFA training. This is the first study in UK and worldwide to look at the effects of psychological first aid on stress and coping in this population and it warrants further investigation.
Taddio A, McGilton KS, Zheng N, Yeung L, Lafleur B, Fung JST, et al.
Can J Pain. 2022;6(1):173–84.
OBJECTIVES: CARD (comfort, ask, relax, distract) is a vaccine delivery framework that includes interventions to improve the patient’s experience. CARD has not been previously implemented in long-term care (LTC) settings. This study evaluated drivers to implementation for COVID-19 vaccinations in an LTC facility. METHODS: Postimplementation interpretive evaluation including qualitative interviews and quantitative surveys with eight participants. The Consolidated Framework for Implementation Research (CFIR) was used for analysis. Adverse reactions to vaccinations and CARD interventions, including local reactogenicity and systemic reactions, were abstracted from medical charts of residents. RESULTS: Eight CFIR constructs emerged. Staff perceived CARD was complex because it added steps to vaccination delivery. Motivated to meet residents’ needs, a receptive implementation climate of support among staff led to using strategies within CARD, such as administering topical anesthetics and omitting alcohol skin antisepsis prior to injections. Having an effective network like the residents council positively influenced implementation by allowing residents to voice their opinions. Facilitators to implementation included staff knowledge and beliefs and staff’s commitment to their organization, which was focused on person-centered care. Barriers included lack of available resources (inadequate staffing), insufficient communication between management and staff and lack of awareness of CARD, and external policies not aligned with CARD. Chart reviews conducted for 93 vaccinated residents corroborated perceptions of vaccination and CARD intervention safety, revealing a low rate of local and systemic adverse reactions and no cases of skin infection. DISCUSSION: We identified positive and negative implementation drivers. Future research is recommended to expand the strategies employed and involve residents more directly.
Borg J, Alam M, Boström AM, Marmstål Hammar L.
Int J Environ Res Public Health. 2022 Sep 28;19(19).
The purpose was to compare selection, use and outcomes of assistive products among older home care clients with and without dementia in Sweden, and to explore the relations between the use of assistive products and perceptions of home care, loneliness and safety. Self-reported data from 89,811 home care clients aged 65 years or more, of whom 8.9% had dementia, were analysed using regression models. Excluding spectacles, 88.2% of them used assistive products. Respondents without dementia were more likely to use at least one assistive product but less likely to use assistive products for remembering. Respondents with dementia participated less in the selection of assistive products, used less assistive products, and benefited less from them. Users of assistive products were more likely to be anxious and bothered by loneliness, to feel unsafe at home with home care, to experience that their opinions and wishes regarding assistance were disregarded by home care personnel, and to be treated worse by home care personnel. The findings raise concerns about whether the needs for assistive products among home care clients with dementia are adequately provided for. They also indicate a need to strengthen a person-centred approach to providing home care to users of assistive products.
Variath C, Peter E, Cranley L, Godkin D.
Palliat�Care. 2022 Jan 1;16:26323524221128840.
Background:In Canada, under Bill C-14, patients who met all eligibility requirements were prevented from accessing medical assistance in dying (MAiD) following their loss of decision-making capacity while awaiting MAiD. The changes introduced with Bill C-7 continue to limit access to patients who did not enter a waiver of final consent agreement with their healthcare providers. Little is known about the experiences with patients? loss of capacity to consent and subsequent ineligibility for MAiD. Understanding healthcare providers? experiences has important implications for improving end-of-life care for those with capacity-limiting conditions.Purpose:To explore Canadian healthcare providers? experiences with end-of-life of eligible patients who became ineligible for MAiD due to their loss of decision-making capacity to consent and the relational influences on their experiences prior to the implementation of Bill C-7 in Canada.Method:A critical qualitative methodology and a feminist ethics theoretical lens guided this study. A voice-centred relational approach that allowed an in-depth exploration of how power, relationality and moral agency influenced participants? experiences was used for data analysis. Data consisted of semi-structured interviews with 30 healthcare providers.Findings:The analysis resulted in the following four main themes and corresponding subthemes: (1) identifying factors that may result in ineligibility for MAiD due to capacity loss; (2) maintaining eligibility required to access MAiD; (3) preparing for an alternative end-of-life; (4) experiencing patients? capacity loss.Discussion:This study highlights that while MAiD is legally available to eligible Canadians, access to MAiD and care for eligible patients who were unable to access MAiD due to their loss of decision-making varied based on the geographical locations and access to willing MAiD and end-of-life care providers. The availability of high-quality palliative care for patients throughout the MAiD process, including following the loss of capacity to consent and subsequent ineligibility, would improve the end-of-life experience for all those involved. The need to establish a systematic approach to prepare and care for patients and their families following the patients? loss of capacity and subsequent ineligibility for MAiD is also identified.
Zhao J, Jull J, Finderup J, Smith M, Kienlin SM, Rahn AC, et al.
BMC Med Inform Decis Mak. 2022 Oct 8;22(1):265.
BACKGROUND: Decision coaching is non-directive support delivered by a trained healthcare provider to help people prepare to actively participate in making healthcare decisions. This study aimed to understand how and under what circumstances decision coaching works for people making healthcare decisions. METHODS: We followed the realist review methodology for this study. This study was built on a Cochrane systematic review of the effectiveness of decision coaching interventions for people facing healthcare decisions. It involved six iterative steps: (1) develop the initial program theory; (2) search for evidence; (3) select, appraise, and prioritize studies; (4) extract and organize data; (5) synthesize evidence; and (6) consult stakeholders and draw conclusions. RESULTS: We developed an initial program theory based on decision coaching theories and stakeholder feedback. Of the 2594 citations screened, we prioritized 27 papers for synthesis based on their relevance rating. To refine the program theory, we identified 12 context-mechanism-outcome (CMO) configurations. Essential mechanisms for decision coaching to be initiated include decision coaches’, patients’, and clinicians’ commitments to patients’ involvement in decision making and decision coaches’ knowledge and skills (four CMOs). CMOs during decision coaching are related to the patient (i.e., willing to confide, perceiving their decisional needs are recognized, acquiring knowledge, feeling supported), and the patient-decision coach interaction (i.e., exchanging information, sharing a common understanding of patient’s values) (five CMOs). After decision coaching, the patient’s progress in making or implementing a values-based preferred decision can be facilitated by the decision coach’s advocacy for the patient, and the patient’s deliberation upon options (two CMOs). Leadership support enables decision coaches to have access to essential resources to fulfill their role (one CMOs). DISCUSSION: In the refined program theory, decision coaching works when there is strong leadership support and commitment from decision coaches, clinicians, and patients. Decision coaches need to be capable in coaching, encourage patients’ participation, build a trusting relationship with patients, and act as a liaison between patients and clinicians to facilitate patients’ progress in making or implementing an informed values-based preferred option. More empirical studies, especially qualitative and process evaluation studies, are needed to further refine the program theory.