Original Title: Soutenir la prise de décision concernant la clôture d’un épisode de services auprès de la clientèle adulte suivie en réadaptation physique

Authors' objectives: This abridged ETMISSS aims to answer the following question: "How can decision-making regarding the end of an episode of care for adults undergoing physical rehabilitation be supported?" The following evaluation questions guided the completion of the mandate: 1. What are the factors or criteria to consider when deciding to end an episode of care? 2. What are the facilitators and obstacles to the decision-making process of ending an episode of care? 3. What tools can support and assist professionals in decision-making regarding the end of an episode of care?

Authors' results and conclusions: The literature search identified 7,203 documents from which 24 publications were selected, including 20 primary studies and four documents from the grey literature. The data from these documents, along with the experiential data obtained from four professionals and managers from three institutions, were triangulated. The analysis of all the data allowed for the formulation of findings on the factors, facilitators, and obstacles to consider when deciding to end a physical rehabilitation episode of care, as well as the tools that can support and assist professionals in this decision-making process. The findings of this abridged ETMI will help support decision-making regarding the ending of a physical rehabilitation episode of care for adults. The analysis of the results and the evaluation of the level of scientific evidence were complicated by the wide range of conditions encountered in physical rehabilitation, and the small number of participants limited the scope of the experiential data. An ETMI or a research project focusing on the applicability of the results in the Quebec context could be interesting avenues to complement the current findings.

Authors' recommendations: The following findings were formulated based on the evaluation of the level of evidence and the convergence of data from the literature and experiential data. Factors or criteria to consider when deciding to end an episode of care • According to a high level of evidence and experiential data, the user’s involvement in the decision to end the episode of care is a criterion to consider. • Without reaching the necessary convergence to achieve a level of evidence, other factors were highlighted in the scientific literature and experiential data, including: the social environment and post-discharge destination, the user's ability in activities of daily living (ADL), their safety, the achievement of a therapeutic plateau, and the chronicity of the user's condition. • The use of intervention termination criteria should also be considered according to experiential data, though this criterion was not echoed in the literature. Facilitators and obstacles to the decision-making process of ending an episode of care • According to a high level of evidence and mentioned in experiential data, support from an interprofessional team facilitates the decision-making process. • According to a high level of evidence and experiential data, caseload pressure, conflicting opinions between colleagues, lack of resources, and discussions with the user or their family members represent obstacles to ending an episode of care. • According to a high level of evidence, waiting for an evaluation by a specialist and legal issues delay the ending of an episode of care. • The difficulty in allowing the user to be involved in the decision was identified as an obstacle according to experiential data, although it has less resonance in the literature. Tools to support and assist professionals in decision-making regarding the ending of an episode of care • Standardized instruments or algorithms specific to different clienteles and conditions were reported, each in a single document in the literature. • In-house instruments specific to the disciplines of the participants involved were mentioned in the experiential data.

Authors' methods: A literature review using a systematic method was conducted. The bibliographic databases CINAHL (EBSCO), Embase (Ovid), and Medline (Ovid) were queried, and a search in the grey literature was also carried out. The literature search for this ETMI covers the period from January 2012 to January 2023. Two professionals divided the tasks after ensuring a shared understanding of the selection and quality assessment criteria. Data extracted using a structured grid were synthesized and then analyzed according to the evaluation questions. Experiential data were collected via semi-structured interviews. These data were compared with the literature data through triangulation.

Project Status: Completed

Year Published: 2024

URL for published report: https://www.ciusss-capitalenationale.gouv.qc.ca/sites/d8/files/docs/MissionUniversitaire/ETMISSS/Rapport-ETMISS_Soutenir-prise-de-decision-cloture-clientele-adulte-readaptation-physique.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