Original Title: Considérations liées au traitement des risques en contexte de soutien à l’autonomie de personnes aînées à domicile et pistes d’action pour soutenir les intervenants

Authors' objectives: The main objective was to answer the question: “From the perspective of HS workers who work with older adults experiencing a loss of autonomy, what organizational, ethical, professional and legal aspects must be considered in order to support them in the uncertainty associated with risk treatment?”

Authors' results and conclusions: Twenty eight scientific articles and three theses and position papers were retained. Discussion groups and interviews were conducted with fifteen care providers from five different professions, three users and their relatives; and three professional advisors. They were recruited from six public institutions in Eastern Quebec providing HC for older adults. A report produced by the Comité national d’éthique sur le vieillissement (2022) was retained as contextual data. Lack of resources and lack of access to existing resources are considered in risk treatment. › Time and workload pressure exerted on care providers by organizations are considered in risk treatment. › Different strategies using individual and organizational flexibility are deployed by care providers to remedy the lack of availability of resources. › Formal and informal exchanges between team members as well as intra- and extra‑organizational clinical support help support decision‑making in a risk context. › A number of difficulties limit collaboration and may affect risk treatment (e.g., lack of continuity; lack of consultation opportunities, lack of recognition and openness). › There are challenges associated with the use of various work tools (e.g., validity and appropriateness). › Some tools can promote decision‑making in a risk context. › There are gaps in information transfer that hinder informed decision‑making.› The central place given, in principle, to the point of view of the user and their relatives is in tension with the consideration of other aspects when making decisions regarding risk (e.g., decision‑making capacity, conflicting values, beliefs and interests). › The perceived role of protecting the user may be in high tension with the central place given to respect for the user’s point of view in decision making. › Risk tolerance is difficult and dependent on each individual, situations and relationships. › There are tensions between the importance of the personalization of services and a close relationship; and the standardization of services and an appropriate professional distance ›The experience of direct intervention in HC can support decision making in a risk context. › There are gaps in initial and continuing training at this time. › Training is important, if not essential, to support decision making in a risk context. › Physical and psychological risks for care providers are considered and their limitations (e.g., prejudices, a priori judgments) can influence risk treatment. › HC workers are concerned about their professional responsibilities and can refer to respect for users’ rights in their practice.

Authors' recommendations: That the necessary resources be allocated to enable care providers to provide appropriate and timely support to users and their relatives (e.g., time allocated for care, travel, clerical tasks, the relationship). › That the reflection initiated on the health and social services network’s capacity to offer services (human, financial and material resources) be continued, with care providers. › That the planning of activities leave sufficient room for manoeuvre in order to adapt to the pace and particularities of the user’s situation at the time of the intervention. › That promising informal initiatives and practices from the field be more widely recognized (e.g., use one’s network of partners). › That teamwork be given more recognition (e.g., that the time invested in building and leading collaborations be considered an integral part of tasks and that care providers have the flexibility needed to carry out these tasks during their working time). › That the opportunities and fluidity of teamwork be reinforced and valued, particularly with respect to formal and informal communication between care providers from: - the same profession; - different professions; - different organizations; - different sectors. › That sharing of responsibilities with clinical supervisors and colleagues be reinforced in a risk context. › That stability of the care provider–user pairings be prioritized. › That the transfer and updating of information be reinforcedand optimized, for example by: - promoting the implementation and use of centralized records; - developing communication tools; - promoting the availability of the work tools required,both clinical and technical (e.g., satellite phones for areas without Internet access) ›That the sharing of responsibilities with users and their relatives be promoted in a risk context (for example, shared decision making). › That care providers be better equipped to feel more ease in ethical decision making, particularly in the context of: - uncertainty about decision‑making autonomy; - the tension between taking the consent of the user and their relatives into consideration and safety; - the tension between standardization and personalization of services; - tension between a close relationship and professional distance. › That HC workers be made aware of the positive aspects of risk taking in the context of respect for the older adult’s decision‑making autonomy hat sharing experience concerning risk treatment in HC be promoted (e.g., community of practice, exchange of case histories, co‑development) between: - experienced and junior care providers; - care providers from different professions; - care providers from different regions. › That the orientation of new care providers be improved, in particular by: - promoting pairing between experienced and junior care providers; - promoting the availability of decision support tools. › That risk treatment in HC be addressed more in all training offered to HC workers. › That training be more accessible so that all HC workers can participate. › That strategies that allow staff to feel safe in the context of interventions be maintained, strengthened or developed. › That care providers be better equipped so that they feel more at ease in ethical decision making, in particular through self‑reflection on: - their values and limitations; - the impact of their values and limitations on risk treatment. › That personalized pairings between care providers and users be favoured. That consultation be encouraged between health and social services institutions, professional orders and the legislator in order to reduce the tensions felt between institutions’ requirements and professional obligations. › That the accessibility of information on the laws, rights and responsibilities of each party be promoted (e.g., notions of consent and capacity) as well as the consultation of people who are mandated and qualified to advise their implementation in the field to reduce the uncertainty with respect to risk treatment.

Authors' methods: Three sources of data were used: (1) scientific data from a systematic review of qualitative literature (CINAHL, Embase, Medline and PsycINFO databases) and grey literature; (2) experiential data collected through focus groups and individual interviews with care providers, users and their relatives and professional advisors; (3) contextual data. The data from these various sources were triangulated in order to generate findings and formulate recommendations.

Project Status: Completed

URL for project: https://www.ciusss-capitalenationale.gouv.qc.ca/sites/d8/files/docs/MissionUniversitaire/ETMISSS/SOMMAIRE-EXECUTIF-CONSIDERATIONS-TRAITEMENT-RISQUES-ANGLAIS.pdf

Year Published: 2024

URL for published report: https://www.ciusss-capitalenationale.gouv.qc.ca/sites/d8/files/docs/MissionUniversitaire/ETMISSS/Rapport-ETMI-classique-SAD.pdf

English language abstract: There is no English language summary available

Publication Type: Full HTA

Country: Canada

Province: Quebec

Organisation Name: Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale

Contact Address: 525, boulevard Wilfrid-Hamel, bureau A-122

Contact Name: Sylvie St-Jacques

Contact Email: uetmisss.deau.ciussscn@ssss.gouv.qc.ca