Interventions for involving older patients with multi-morbidity in decision-making during primary care consultations

Butterworth, Joanne; Hays, Rebecca; McDonagh, Sinéad T J; Richards, Suzanne H; Bower, Peter; Campbell, John

doi:10.1002/14651858.cd013124.pub2

Cited by 15 publications

(19 citation statements)

References 113 publications

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“…Shared decision-making during general practice consultations for older people with multimorbidity is currently under-researched and poorly understood [8]. However, emerging clinical guidelines for the management of multimorbidity have advised on a personalised, patientcentred approach when balancing the risks and benefits of treatment; to reduce treatment burden, and to focus on quality of life as well as on specific disease control [33,34].…”

Section: Discussionmentioning

confidence: 99%

“…Social and behavioural science theory was used to describe factors affecting older patients' involvement in decision-making about their healthcare, as well as methods for improvement. Evidence from a systematic review [8], from patient, public and expert opinion and from a focus group study with older patients with multimorbidity and with GPs, enabled the refinement of logic models underpinning this work. The Intervention Mapping process will be published separately.…”

Section: The Interventionmentioning

confidence: 99%

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Randomised feasibility trial and embedded qualitative process evaluation of a new intervention to facilitate the involvement of older patients with multimorbidity in decision-making about their healthcare during general practice consultations: the VOLITION study protocol

Butterworth

Richards

Warren

et al. 2020

Pilot Feasibility Stud

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Background The number of older people with multiple health problems is increasing worldwide. This creates a strain on clinicians and the health service when delivering clinical care to this patient group, who themselves carry a large treatment burden. Despite shared decision-making being acknowledged by healthcare organisations as a priority feature of clinical care, older patients with multimorbidity are less often involved in decision-making when compared with younger patients, with some evidence suggesting associated health inequalities. Interventions aimed at facilitating shared decision-making between doctors and patients are outdated in their assessments of today’s older patient population who need support in prioritising complex care needs in order to maximise quality of life and day-to-day function. Aims To undertake feasibility testing of an intervention (‘VOLITION’) aimed at facilitating the involvement of older patients with more than one long-term health problem in shared decision-making about their healthcare during GP consultations. To inform the design of a fully powered trial to assess intervention effectiveness. Methods This study is a cluster randomised controlled feasibility trial with qualitative process evaluation interviews. Participants are patients, aged 65 years and above with more than one long-term health problem (multimorbidity), and the GPs that they consult with. This study aims to recruit 6 GP practices, 18 GPs and 180 patients. The intervention comprises two components: (i) a half-day training workshop for GPs in shared decision-making; and (ii) a leaflet for patients that facilitate their engagement with shared decision-making. Intervention implementation will take 2 weeks (to complete delivery of both patient and GP components), and follow-up duration will be 12 weeks (from index consultation and commencement of data collection to final case note review and process evaluation interview). The trial will run from 01/01/20 to 31/01/21; 1 year 31 days. Discussion Shared decision-making for older people with multimorbidity in general practice is under-researched. Emerging clinical guidelines advise a patient-centred approach, to reduce treatment burden and focus on quality of life alongside disease control. The systematic development, testing and evaluation of an intervention is warranted and timely. This study will test the feasibility of implementing a new intervention in UK general practice for future evaluation as a part of routine care. Trial registration CLINICAL TRIALS.GOV registration number NCT03786315, registered 24/12/18

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Section: Discussionmentioning

confidence: 99%

Section: The Interventionmentioning

confidence: 99%

Randomised feasibility trial and embedded qualitative process evaluation of a new intervention to facilitate the involvement of older patients with multimorbidity in decision-making about their healthcare during general practice consultations: the VOLITION study protocol

Butterworth

Richards

Warren

et al. 2020

Pilot Feasibility Stud

Self Cite

View full text Add to dashboard Cite

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“…A patient-centred approach in which older persons are more actively involved in their own health could help increase self-management and might have a beneficial impact on health [1,2]. A patient-centred approach also accords with current trends towards shared decision making and personalised healthcare.…”

Section: Introductionmentioning

confidence: 99%

“…Indeed, many older persons wish to be informed about their own health, although there is wide individual variation [3]. Results from earlier studies also indicate that they are less inclined than younger people to take decisions concerning their own healthcare [2,4,5]. It has been suggested that monitoring one's own health can stimulate patient involvement in medical decisions [6,7].…”

Section: Introductionmentioning

confidence: 99%

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Older individuals’ views on their personal screening results for complex health problems: a qualitative study

Blijswijk¹,

Tol²,

Blom³

et al. 2020

BMC Fam Pract

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Background Providing older persons with information about their health status may increase their involvement in their own health and enhance self-management. However, we need a better understanding of how older persons view their personal results after completing a screening questionnaire on complex health, of their (lack of) motivation and their subsequent action. Methods In this qualitative study community-dwelling older persons (≥80 years, n = 13) who completed a screening questionnaire on complex health problems were interviewed regarding their perception of the results, the actions they considered taking and their personal motivations. Data were analysed thematically (qualitative content analyses). Results Participants expressed interest in feedback, as an objective questionnaire might substantiate their own views regarding their personal health. They were mostly unsurprised by the results and/or had already taken precautions and were therefore not inclined to undertake additional action. They admitted difficulty with and appreciated advice from a professional regarding preparation of an action plan. Unexpected negative results would lead them to discuss matters with family and/or their general practitioner, provided they had a good relationship with their GP. Conclusion Older people were interested in direct feedback regarding their screening questionnaire results and in subsequent advice on possible additional measures. General practices could consider inviting older persons to complete a screening questionnaire and discuss activities and personal goals. This information could serve to better shape future interventions aimed at increasing self-management amongst older persons.

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What are the benefits and harms of involving older adults in their healthcare decision-making process?

Gupta¹

2020

Cochrane Clinical Answers

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Interventions for involving older patients with multi-morbidity in decision-making during primary care consultations

Abstract: Interventions for involving older patients with multimorbidity in decision-making during primary care consultations.

Cited by 15 publications

References 113 publications

Randomised feasibility trial and embedded qualitative process evaluation of a new intervention to facilitate the involvement of older patients with multimorbidity in decision-making about their healthcare during general practice consultations: the VOLITION study protocol

Randomised feasibility trial and embedded qualitative process evaluation of a new intervention to facilitate the involvement of older patients with multimorbidity in decision-making about their healthcare during general practice consultations: the VOLITION study protocol

Older individuals’ views on their personal screening results for complex health problems: a qualitative study

What are the benefits and harms of involving older adults in their healthcare decision-making process?

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