Empowering Shared Decision-Making in Community-Based Care: Implementing the Living with Risk: Decision Support Approach (LwR:DSA)
TL;DR
Embedding structured, person-centred decision support for the risk assessment process fosters meaningful partnerships between older adults, care partners, and providers and suggests that targeting teams through tailored training, debriefing, and team-building activities enhances sustainability of LwR:DSA adoption.
Abstract
Background: Older adults living with frailty often face care decisions that prioritize safety over autonomy. The Living with Risk: Decision Support Approach (LwR:DSA) was developed to guide structured, person-centred conversations about risk that align care plans with what matters most to the individual. Early evidence showed benefits for both clients and providers, yet strategies for adopting the LwR:DSA into routine hospital and community practice to achieve these outcomes were not well understood. Approach: Twenty-five multidisciplinary providers across hospital and community settings implemented the LwR:DSA in usual care over eight weeks with community-dwelling older adults. Participants received tailored training, coaching, and access to implementation tools informed by the Consolidated Framework for Implementation Research. A multi-methods design gathered qualitative and quantitative data on adoption, barriers and facilitators to uptake, and clinical outcomes. Results: Eighty percent of participants used the LwR:DSA at least once during the eight-week trial. Providers reported improvements across multiple domains: Communication: Structured and respectful discussions that elicited multiple perspectives, clarified complex situations, and streamlined documentation. Conversations became more consistent, objective, and collaborative, enhancing advocacy and mutual understanding. Clinical Thinking and Decision-Making: The LwR:DSA helped providers synthesize diverse information, organize and validate reasoning, and make implicit judgments more explicit. It supported identification of concerns, exploration of alternatives, and articulation of rationale, fostering shared and informed decisions. Therapeutic Relationships: The approach deepened trust and rapport by promoting dignified, client-centred dialogue. Older adults and care partners felt heard, informed, and empowered to participate actively in decisions about risk for harms and care. Team Collaboration: Participants emphasized the added value of adopting the LwR:DSA as an interprofessional team. Learning and applying the approach together enhanced problem-solving, reflection, and skill mastery, while distributing the cognitive demands of new practice. Team-level facilitators such as respect, psychological safety, and shared purpose enabled open dialogue about risk for harms —an essential condition for implementation success. Consistent with broader literature, the findings suggest that targeting teams (rather than individuals) through tailored training, debriefing, and team-building activities enhances sustainability of LwR:DSA adoption. Implications: Embedding structured, person-centred decision support for the risk assessment process fosters meaningful partnerships between older adults, care partners, and providers. The LwR:DSA operationalizes integrated care principles by aligning clinical reasoning with individual goals, promoting autonomy within safe systems, and strengthening interprofessional collaboration. The study demonstrates how empowering teams and clients to engage in shared decision-making can advance integration, equity, and improved outcomes in community-based care when there are identified safety concerns.