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dc.contributor.authorBunn, Frances
dc.contributor.authorGoodman, Claire
dc.contributor.authorRussell, Bridget
dc.contributor.authorWilson, Patricia
dc.contributor.authorManthorpe, Jill
dc.contributor.authorRait, Greta
dc.contributor.authorHodkinson, Isabel
dc.contributor.authorDurand, Marie-Anne
dc.date.accessioned2018-08-16T00:18:19Z
dc.date.available2018-08-16T00:18:19Z
dc.date.issued2018-07-18
dc.identifier.citationBunn , F , Goodman , C , Russell , B , Wilson , P , Manthorpe , J , Rait , G , Hodkinson , I & Durand , M-A 2018 , ' Supporting shared decision making for older people with multiple health and social care needs: a realist synthesis ' , BMC Geriatrics , vol. 18 , no. 65 , 165 . https://doi.org/10.1186/s12877-018-0853-9
dc.identifier.issn1471-2318
dc.identifier.otherPURE: 15108193
dc.identifier.otherPURE UUID: 30f145d8-b7dd-4e99-bdf1-c56176edad80
dc.identifier.otherScopus: 85050341657
dc.identifier.urihttp://hdl.handle.net/2299/20463
dc.description© The Author(s). 2018
dc.description.abstractBackground Health care systems are increasingly moving towards more integrated approaches. Shared decision making (SDM) is central to these models but may be complicated by the need to negotiate and communicate decisions between multiple providers, as well as patients and their family carers; particularly for older people with complex needs. The aim of this review was to provide a context relevant understanding of how interventions to facilitate SDM might work for older people with multiple health and care needs, and how they might be applied in integrated care models. Methods Iterative, stakeholder driven, realist synthesis following RAMESES publication standards. It involved: 1) scoping literature and stakeholder interviews (n = 13) to develop initial programme theory/ies, 2) systematic searches for evidence to test and develop the theories, and 3) validation of programme theory/ies with stakeholders (n = 11). We searched PubMed, The Cochrane Library, Scopus, Google, Google Scholar, and undertook lateral searches. All types of evidence were included. Results We included 88 papers; 29 focused on older people or people with complex needs. We identified four context-mechanism-outcome configurations that together provide an account of what needs to be in place for SDM to work for older people with complex needs. This includes: understanding and assessing patient and carer values and capacity to access and use care, organising systems to support and prioritise SDM, supporting and preparing patients and family carers to engage in SDM and a person-centred culture of which SDM is a part. Programmes likely to be successful in promoting SDM are those that allow older people to feel that they are respected and understood, and that engender confidence to engage in SDM. Conclusions To embed SDM in practice requires a radical shift from a biomedical focus to a more person-centred ethos. Service providers will need support to change their professional behaviour and to better organise and deliver services. Face to face interactions, permission and space to discuss options, and continuity of patient-professional relationships are key in supporting older people with complex needs to engage in SDM. Future research needs to focus on inter-professional approaches to SDM and how families and carers are involved.en
dc.format.extent16
dc.language.isoeng
dc.relation.ispartofBMC Geriatrics
dc.subjectMultimorbidity
dc.subjectOlder people
dc.subjectPerson-centred care
dc.subjectRealist synthesis
dc.subjectShared decision making
dc.subjectGeriatrics and Gerontology
dc.titleSupporting shared decision making for older people with multiple health and social care needs: a realist synthesisen
dc.contributor.institutionCentre for Research in Public Health and Community Care
dc.contributor.institutionEvidence Based Practice
dc.contributor.institutionNursing, Midwifery and Social Work
dc.contributor.institutionOlder People's Health and Complex Conditions
dc.contributor.institutionSchool of Health and Social Work
dc.contributor.institutionWeight and Obesity Research Group
dc.description.statusPeer reviewed
dc.identifier.urlhttp://www.scopus.com/inward/record.url?scp=85050341657&partnerID=8YFLogxK
rioxxterms.versionVoR
rioxxterms.versionofrecordhttps://doi.org/10.1186/s12877-018-0853-9
rioxxterms.typeJournal Article/Review


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