Design and evaluation of an implementation intervention to enhance decision support by call centre nurses for callers facing values-sensitive health decisions.

Abstract

Purpose. To evaluate the process of implementing decision support by call centre nurses for callers facing values-sensitive health decisions. Design. Exploratory case study guided by the Ottawa Model of Research Use with an embedded randomized controlled trial. Setting. A Canadian province-wide call centre. Intervention. Online autotutorial, skill-building workshop, decision support protocol, and performance feedback using simulated callers. Methods. (1) Barriers assessment using a survey, interviews, focus groups, and quality audit of baseline simulated calls. (2) Comparison of intervention and control groups using a knowledge test, quality audit of simulated calls, and acceptability surveys. (3) Assessment of the uptake and sustainability of decision support using a survey, interviews, and focus groups. Results. (1) Of 108 nurses, 57 responded to the barriers survey. Nurses had positive attitudes toward patient participation in decision making and their role in supporting callers. Main barriers included inadequate nurses' knowledge, skills, and confidence in providing decision support; lack of process to guide decision support calls; patient decision aids not formatted for telephone use; low public awareness; pressure to minimize call length, and unclear program direction. (2) Compared to controls (n=20), nurses (n=19) who participated in the intervention had improved knowledge (M= 74% vs. 60%, p=0.007) and provided a higher quality of decision support particularly in the domains of discussing values and support (M= 81.3% vs. 45.8%,p<0.0001) without significantly increasing call duration (M= 18.5 vs. 16.7 min, p=0.73). Nurses were satisfied with the multifaceted intervention. Twelve control group nurses opted to complete the training after the trial concluded. (3) Within 3 months post-intervention, 25 of the 31 nurses (n=19+12) completed the decision support uptake survey. Of these, 44% had used the protocol with real callers and 88% intended to use it. Nurses spoke positively about their experiences with real callers. Suggestions to improve sustainability included integrating the protocol in the call centre database, reformatting the patient decision aids, clarifying the program direction, establishing call length guidelines tailored to call type, implementing decision support training for all staff, and publicizing the new decision support services. Conclusions. The multifaceted intervention and process evaluation measures may provide a feasible approach to expanding call centre services to include values-sensitive decision support. However, to ensure sustainability, barriers within the practice environment need to be addressed and patient outcomes evaluated.