Co-designing an intervention to promote shared decision-making with older people, with frailty, in planning discharge from hospital
Abstract
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.
Comments
Very interesting topic. How…
Very interesting topic. How significant do you think this intervention could be in improving shared decision making during discharge planning for older adults with frailty?
Thank you
Thank you for your kind feedback! Am glad you found it very interesting. I believe this will be highly significant as this research is underpinned by realist methodology combined with co-design methodology which provides the researchers with a deep understanding of underlying mechanisms which cause an intervention to succeed. Context-Mechanism-Outcome (CMO) configurations are being used to test and refine programme theory. Older people, families/carers and a wide range of health and social care professionals with experience of hospital discharge for older people with frailty have been included in the co-design phases of this study thus exceptional diverse perspective. I trust you find this helpful. Renewed thanks for your comment.
This is a highly interesting…
This is a highly interesting and relevant study, as it addresses a perspective that is widely recognized as essential in the care of older adults, yet remains insufficiently incorporated into clinical practice. Shared decision-making, particularly in the context of hospital discharge for people living with frailty, represents a significant challenge for healthcare professionals, as well as for older individuals and their families.
The study appropriately highlights the importance of sharing information in a clear, accessible, and safe manner, which is a key element in ensuring the engagement of all those involved in the care process. Furthermore, it underscores the need for better organization of care, with the active inclusion of family members and caregivers in decision-making, which is particularly relevant given the complexity of health conditions and the demands of ongoing care.