Shared decision-making in general practice: Development of a complex health care intervention targeting multiple long-term conditions.

Abstract

People with multiple long-term health conditions (MLTC) live with the burden of illness and treatments, reduced quality of life and healthcare costs. Ensuring high-quality care for these patients is challenging. Potential benefits of shared decision-making (SDM) are acknowledged, including patient trust, satisfaction and adherence with care. However, few interventions are designed, in context, to facilitate SDM for this patient group. Development and refinement of a complex intervention (patient- and practitioner-facing) to facilitate the involvement of older people living with MLTC in SDM during UK GP consultations. An Intervention Mapping (IM) framework was applied to systematically incorporate existing literature, relevant theory and new data in intervention development and refinement within a socioecological model for health care. Use of IM also enabled identification of contextual factors that might affect implementation, to determine intervention components that may need to be tailored in context. Logic models were used to diagrammatically present programme theory. Patient and public involvement and expert stakeholder opinion were central to intervention development, alongside three core studies (Cochrane review of similar interventions, focus groups with patients and GPs, a mixed-methods exploratory-explanatory study to inform implementation and evaluation planning). The VOLITION intervention consists of a prompt to patients inviting them to express their personal preferences for involvement and holistic priorities, and training for practitioners in delivering a patient-tailored approach to SDM whilst addressing contextual challenges. VOLITION adheres to international policy for personalised care (e.g., the UK National Institute for Health and Care Excellence guidance for SDM). The approach outlined here aligns to international guidance for the development of complex interventions. An effective SDM intervention, designed using end-user perspectives, and evaluated as a complex intervention, offers potential to influence policy, to improve patient and practitioner experiences of care, patient enablement, positive health outcomes and cost-effective care.