Supporting shared decision-making for older people with multiple health and social care needs: a protocol for a realist synthesis to inform integrated care models.
Including the patient or user perspective is a central organising principle of integrated care. Moreover, there is increasing recognition of the importance of strengthening relationships among patients, carers and practitioners, particularly for individuals receiving substantial health and care support, such as those with long-term or multiple conditions. The overall aims of this synthesis are to provide a context-relevant understanding of how models to facilitate shared decision-making (SDM) might work for older people with multiple health and care needs, and how they might be applied to integrated care models.



The synthesis draws on the principles of realist inquiry, to explain how, in what contexts and for whom, interventions that aim to strengthen SDM among older patients, carers and practitioners are effective. We will use an iterative, stakeholder-driven, three-phase approach. Phase 1: development of programme theory/theories that will be tested through a first scoping of the literature and consultation with key stakeholder groups; phase 2: systematic searches of the evidence to test and develop the theories identified in phase 1; phase 3: validation of programme theory/theories with a purposive sample of participants from phase 1. The synthesis will draw on prevailing theories such as candidacy, self-efficacy, personalisation and coproduction.



Ethics approval for the stakeholder interviews was obtained from the University of Hertfordshire ECDA (Ethics Committee with Delegated Authority), reference number HSK/SF/UH/02387. The propositions arising from this review will be used to develop recommendations about how to tailor SDM interventions to older people with complex health and social care needs in an integrated care setting.
Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK.
Frances
F
Bunn
Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK.
Claire
C
Goodman
Social Care Workforce Research Unit, King's College London, London, UK.
Jill
J
Manthorpe
The Preference Laboratory, The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire, USA.
Marie-Anne
MA
Durand
Tower Hamlets Clinical Commissioning Group, The Tredegar Practice, London, UK.
Isabel
I
Hodkinson
Research Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus), London, UK.
Greta
G
Rait
University of Hertfordshire, Hatfield, UK.
Paul
P
Millac
Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK.
Sue L
SL
Davies
Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK.
Bridget
B
Russell
Centre for Health Service Studies, University of Kent, Canterbury, UK.
Patricia
P
Wilson
D000368:Aged; D003657:Decision Making; D003695:Delivery of Health Care; D006296:Health Services; D006801:Humans; D018802:Patient-Centered Care / Q000458:organization & administration*; D012947:Social Work; D013222:State Medicine / Q000458:organization & administration*; D006113:United Kingdom
Older people; Shared decision making; long term conditions; multimorbidity; realist synthesis