Understanding the Barriers and Facilitators for Healthcare Professionals to Adopt the ‘Living With Risk: Decision Support Approach’ Into the Hospital and Community Settings

Abstract

Health care professionals (HCPs) tend to overprotect older adults when there are safety concerns and over focus on the potential negative and physical consequences. HCPs should instead be engaging older adults in a balanced, broadened and strength-based approach to risk assessment and management. This approach leverages older adults’ strengths and considers the negative and positive emotional, social and physical consequences of perceived risky decisions. The Living with Risk: Decision Support Approach (LwR:DSA) incorporates and operationalizes these elements and its use has led to improved communication, clinical thinking, decision making and efficiencies in the care process. Yet little is known on how best to adopt the LwR:DSA into hospital and community settings. To address this evidence gap, this study aimed to identify, describe and understand the characteristics of the client, practice setting, HCP, LwR:DSA, and implementation process that facilitated or inhibited the adoption of the LwR:DSA in these two practice settings. The second aim was to optimize future adoption of the approach by improving the LwR:DSA and the four pre-selected implementation strategies (training videos, instruction guide, worksheets, and bi-monthly emails) and develop new implementation strategies based on the findings of the first aim. A concurrent multimethods study was used to answer these questions by gathering qualitative and quantitative data pre-, during and post-use of the LwR:DSA for eight weeks. The Consolidated Framework for Implementation Research (CFIR 1.0) was chosen as the theoretical framework to guide data collection, data analysis and development of the implementation strategies. Findings revealed that 80% of the participants (20/25) adopted the LwR:DSA at least once over an eight-week period with consistent use of all implementation strategies. The participants identified 17 anticipated and 20 actual determinants of adoption across all five CFIR domains, with the majority being facilitators. While the four implementation strategies were helpful for initial adoption they were not sufficient for continued use as 70% of the participants indicated that they could have used the LwR:DSA more. The anticipated and actual determinants were then used to tailor the existing implementation strategies and provide suggestions for future strategies to support full implementation and sustainability of the LwR:DSA.