title: Older patients and their GPs: shared decision making in enhancing trust.
abstract: BACKGROUND
  Older patients differ from younger patients in their perceptions of trust in doctors; their sense of shared decision making is particularly associated with their trust in the GP. Enhancing trust and improving shared decision making are thought to have positive health outcomes. Older patients are sometimes reported as being less frequently involved in decisions about their health care, however, and in having more unmet healthcare needs than younger patients.
  
  
  OBJECTIVE
  This study explored older patients' trust in their GPs and their perceptions of shared decision making.
  
  
  METHODS
  Qualitative methods were used. Systematic sampling identified 20 participants, aged ≥65 years, from three GP surgeries in Devon, UK.
  
  
  METHODS
  A constant comparative approach was applied to thematic analysis of transcribed interviews.
  
  
  RESULTS
  All participants valued feeling involved in decisions but differed regarding how they felt involved. Trust influenced preferences for shared decision making: a trusted GP 'ally', to competently manage participants' increasing health-information requirements throughout the vulnerable ageing process, was important. Trust was affected by factors contributing to the facilitation of involvement. GP characteristics, communication skills, consultation duration, and continuity of care were common themes.
  
  
  CONCLUSIONS
  Although limited geographically and subsequently by ethnic group, the present sample allows for reasonable transferability of the study to other UK populations. A range of factors are highlighted for consideration when planning primary healthcare delivery: to facilitate the optimal involvement of older patients in decisions about their health care, while enhancing their trust in the GP; to help minimise potential health inequalities for this patient group.
authors.affiliation: Primary Care Research Group, University of Exeter Medical School, Exeter, UK.
authors.forename: Joanne E
authors.initials: JE
authors.lastname: Butterworth
authors.affiliation: Primary Care Research Group, University of Exeter Medical School, Exeter, UK.
authors.forename: John L
authors.initials: JL
authors.lastname: Campbell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D003657:Decision Making; D005260:Female; D058005:General Practitioners; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D010358:Patient Participation; D057240:Patient Preference; D010817:Physician-Patient Relations; D012494:Sampling Studies; D035502:Trust; D006113:United Kingdom
keywords: GP; communication skills; elderly; general practice; older patients; primary care; shared decision making; trust