Co-designing an intervention to promote shared decision-making with older people, with frailty, in planning discharge from hospital

Background:

Effective planning for hospital discharge can best be achieved through shared decision-making to make fully informed decisions. However shared decision-making is challenging for both healthcare professionals and older people with frailty. There is limited consensus on the optimum way to achieve shared decision-making. This project aims to develop a multi-component intervention to prepare healthcare professionals, older people, and relatives/carers of older people to engage in shared decision-making. We will test the feasibility of implementing the intervention in Northern Ireland within the hospital discharge process.

Methods:

This realist evaluation will proceed in three stages:

1. Realist review of the literature to formulate initial programme theory, including the impact of context and the identification of uncertainties.

2. Co-design of the intervention to ensure inclusion of diverse stakeholders through Focus Group interviews and Co-design Workshops.

3. Implementation and process evaluation of the intervention.

Results:

This presentation reports on the codesign of the intervention. We conducted three Focus Group interviews and four Co-design Workshops involving stakeholders: older people, relatives of older people, and a range of health and social care professionals from the professions of medicine, nursing, occupational therapy, pharmacy, physiotherapy, social work and general practice medicine. Findings highlight the need for better information-sharing with older people, for earlier engagement with relatives/carers, for language to be simplified and for staff confidence to be enhanced in order to improve outcomes for older people living with frailty.

Conclusion:

A multi-component intervention was developed to help prepare older people, relatives/carers and healthcare professionals for engagement with shared decision-making. The intervention encompasses Shared Decision-Making Ambassadors and an online resource. Feasibility testing will further refine programme theory to determine what works for whom, how, why and in what circumstances.