Shifting from “What is the matter?” to “What matters to you?” Shared decision making for older adults with multiple chronic conditions and their informal caregivers

Shared decision making (SDM) contributes to personalized decisions that fit patients’ preferences when choosing treatment for a condition. However, older adults often experience multiple chronic conditions (MCCs). Therefore, the implementation of SDM requires special characteristics. The aim of this thesis was to describe the development and evaluation of an intervention to improve SDM in older adults with MCC.
Following the Medical Research Council framework for developing complex interventions, the SDM^MCC intervention was developed step-wise. First, a literature review on barriers and facilitators for SDM and empirical research about older adults’ views and preferences on important health topics were conducted. Secondly, we developed the measuring instrument Observer OPTION^MCC for SDM with older adults with MCCs. Subsequently, in a co-creation process with end-users, we developed a training for geriatricians and a preparatory tool for older adults with MCCs and informal caregivers. After assessing feasibility, the intervention was implemented and evaluated in a pragmatic trial (N=216) in geriatric outpatient clinics of two Dutch hospitals. Finally, we studied the influence of personal characteristics of older adults, such as health literacy, anxiety and education in participation and outcomes of SDM.
The SDM^MCC intervention resulted in improvement in the discussion of a number of essential SDM topics, while other topics declined. The process evaluation showed clear indicators for how the intervention could be further improved to also result in effects on the reported outcomes of patients and caregivers. Tailoring SDM communication to health literacy levels is important for high-quality SDM communication and thus for better outcomes.