Shared Decision-Making on Tobacco Smoking by Older Adults Living in Residential Care Facilities: Care Professionals' Perspectives.

Objectives: Older adults with physical or cognitive disabilities may need to move to residential care facilities (RCFs). Some older adults smoke tobacco and become dependent on their care professionals to continue smoking. Care professionals need to balance an individual resident's quality of life and well-being with the health and safety of all residents and staff. Shared decision-making (SDM) could support care professionals in these dilemmas. This study assesses multiple factors that could affect care professionals' behavior and degree of SDM regarding residents' tobacco use.

Design: We conducted quantitative cross-sectional research.

Setting and participants: We included care professionals working in psychogeriatric and somatic units in Dutch RCFs.

Methods: Data were collected with an online or hard copy survey and analyzed with t-tests and regression analyses using SPSS.

Results: Care professionals' positive attitudes toward residents' tobacco use are significantly associated with a lower degree of SDM concerning this use and enabling residents to smoke more often. The degree of SDM regarding residents' tobacco use is significantly positively associated with limiting residents' tobacco use and the degree of person-centered care (PCC). Care professionals working in somatic units report a significantly higher degree of SDM regarding residents' tobacco use compared with those working in psychogeriatric units.

Conclusions and implications: Residents' wish to smoke tobacco is a complex matter within RCFs. Care professionals' attitudes cause inconsistencies in their behavior and the degree of SDM. Moreover, care professionals tend to use SDM more often when they need to limit residents' use and cannot fulfill residents' unhealthy habits, such as smoking tobacco. SDM could support care professionals to deal with dilemmas regarding residents' tobacco use by including residents in decisions, regardless of the outcome. However, multiple factors affect care professionals' behavior and the degree of SDM. Especially, their attitudes need to be addressed. SDM is further complicated by national acts and organizational policies.