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Related Experiment Video

Updated: May 15, 2026

E-Patient Counseling Trial (E-PACO): Computer Based Education versus Nurse Counseling for Patients to Prepare for Colonoscopy

E-Patient Counseling Trial (E-PACO): Computer Based Education versus Nurse Counseling for Patients to Prepare for Colonoscopy

Published on: August 1, 2019

Provider staffing effect on a decision aid intervention.

Mary Ersek¹, Justine S Sefcik, Feng-Chang Lin

¹Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA.

Clinical Nursing Research

|January 8, 2013

Summary

This summary is machine-generated.

A decision aid improved surrogate discussions about feeding options in dementia care, especially when Nurse Practitioners (NPs) and Physician Assistants (PAs) were not full-time. Full-time NP/PA staffing also supported better decision-making.

Keywords:

advance practice nursing decision making dementia nursing home nutrition

Related Experiment Videos

Last Updated: May 15, 2026

E-Patient Counseling Trial (E-PACO): Computer Based Education versus Nurse Counseling for Patients to Prepare for Colonoscopy

E-Patient Counseling Trial (E-PACO): Computer Based Education versus Nurse Counseling for Patients to Prepare for Colonoscopy

Published on: August 1, 2019

Area of Science:

Gerontology
Health Services Research
Clinical Decision Support

Background:

Effective surrogate decision-making is crucial for individuals with dementia in nursing homes.
The roles of advanced practice providers like Nurse Practitioners (NPs) and Physician Assistants (PAs) in facilitating these discussions are not fully understood.
Decision aids can support surrogates, but their effectiveness may vary based on staffing models.

Purpose of the Study:

To investigate the impact of Nurse Practitioner (NP) and Physician Assistant (PA) staffing levels on surrogate decision-making in nursing homes.
To evaluate the effectiveness of a decision aid for feeding options in dementia on surrogate-provider discussions and decisional conflict.
To determine if NP/PA staffing modifies the effect of the decision aid.

Main Methods:

A comparative study involving 256 surrogate decision-makers across 24 nursing homes.
Nursing homes were categorized by NP/PA staffing: none, part-time, or full-time.
Outcomes measured included the frequency of surrogate-provider discussions and surrogate decisional conflict, comparing intervention (decision aid) and control groups.

Main Results:

The decision aid significantly increased discussion rates in facilities with no or part-time NP/PA staffing (from 13% to 41% and 26% to 51%, respectively).
The decision aid significantly decreased decisional conflict scores in facilities with no or part-time NP/PA staffing.
Facilities with full-time NP/PA staffing demonstrated high baseline discussion rates (41%) and were not significantly impacted by the decision aid.

Conclusions:

Both the decision aid and full-time NP/PA staffing can enhance surrogate decision-making processes in nursing home settings.
The decision aid is particularly beneficial in facilities with limited or no NP/PA presence.
Optimizing staffing models and utilizing decision support tools can improve care quality for nursing home residents with dementia.