title: Expert and patient consensus on a dynamic model for shared decision-making in frail older patients.
abstract: OBJECTIVE
  Shared decision-making (SDM) is widely recommended as a way to support patients in making healthcare choices. Due to an ageing population, the number of older patients will increase. Existing models for SDM are not sufficient for this patient group, due to their multi-morbidity, the lack of guidelines and evidence applicable to the numerous combinations of diseases. The aim of this study was to gain consensus on a model for SDM in frail older patients with multiple morbidities.
  
  
  METHODS
  We used a three-round Delphi study to reach consensus on a model for SDM in older patients with multiple morbidities. The expert panel consisted of 16 patients (round 1), and 59 professionals (rounds 1-3). In round 1, the SDM model was introduced, rounds 2 and 3 were used to validate the importance and feasibility of the SDM model.
  
  
  RESULTS
  Consensus for the proposed SDM model as a whole was achieved for both importance (91% panel agreement) and feasibility (76% panel agreement).
  
  
  CONCLUSIONS
  SDM in older patients with multiple morbidities is a dynamic process. It requires a continuous counselling dialogue between professional and patient or proxy decision maker.
  
  
  CONCLUSIONS
  The developed model for SDM in clinical practice may help professionals to apply SDM in the complex situation of the care for older patients.
authors.affiliation: Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Postbus 9101, 6500 HB Nijmegen, The Netherlands. Electronic address: Marjolein.vandepol@radboudumc.nl.
authors.forename: Marjolein H J
authors.initials: MH
authors.lastname: van de Pol
authors.affiliation: Academic Educational Institute, Radboud University Nijmegen Medical Centre, Postbus 9101, 6500 HB Nijmegen, The Netherlands. Electronic address: lia.fluit@radboudumc.nl.
authors.forename: Cornelia R M G
authors.initials: CR
authors.lastname: Fluit
authors.affiliation: Department of Internal Medicine, Haga Teaching Hospital, Postbus 40551, 2504 LN The Hague, The Netherlands. Electronic address: j.lagro@hagaziekenhuis.nl.
authors.forename: Joep
authors.initials: J
authors.lastname: Lagro
authors.affiliation: Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Postbus 9101, 6500 HB Nijmegen, The Netherlands. Electronic address: yvonne_slaats@hotmail.com.
authors.forename: Yvonne H P
authors.initials: YH
authors.lastname: Slaats
authors.affiliation: Department of Geriatrics, Radboud University Nijmegen Medical Centre, Postbus 9101, 6500 HB Nijmegen, The Netherlands. Electronic address: marcel.olderikkert@radboudumc.nl.
authors.forename: Marcel G M
authors.initials: MG
authors.lastname: Olde Rikkert
authors.affiliation: Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Postbus 9101, 6500 HB Nijmegen, The Netherlands. Electronic address: toine.lagro@radboudumc.nl.
authors.forename: Antoine L M
authors.initials: AL
authors.lastname: Lagro-Janssen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D032921:Consensus; D003657:Decision Making; D003661:Decision Support Techniques; D003697:Delphi Technique; D016330:Frail Elderly; D005853:Geriatrics; D006801:Humans; D009017:Morbidity; D010358:Patient Participation
keywords: Care for older persons; Clinical practice; Delphi study; Geriatrics; Multi-morbidity; Shared decision-making