Supporting shared decision-making for older people with multiple heath and social care needs: a protocol for a realist synthesis to inform integrated care models

摘要

Introduction: Including the patient or user perspectiveudis a central organising principle of integrated care.udMoreover, there is increasing recognition of theudimportance of strengthening relationships amongudpatients, carers and practitioners, particularly forudindividuals receiving substantial health and careudsupport, such as those with long-term or multipleudconditions. The overall aims of this synthesis are toudprovide a context-relevant understanding of howudmodels to facilitate shared decision-making (SDM)udmight work for older people with multiple health andudcare needs, and how they might be applied toudintegrated care models.udMethods and analysis: The synthesis draws on theudprinciples of realist inquiry, to explain how, in whatudcontexts and for whom, interventions that aim toudstrengthen SDM among older patients, carers andudpractitioners are effective. We will use an iterative,udstakeholder-driven, three-phase approach. Phase 1:uddevelopment of programme theory/theories that will beudtested through a first scoping of the literature andudconsultation with key stakeholder groups; phase 2:udsystematic searches of the evidence to test and developudthe theories identified in phase 1; phase 3: validationudof programme theory/theories with a purposive sampleudof participants from phase 1. The synthesis will drawudon prevailing theories such as candidacy, self-efficacy,udpersonalisation and coproduction.udEthics and dissemination: Ethics approval for theudstakeholder interviews was obtained from theudUniversity of Hertfordshire ECDA (Ethics Committeeudwith Delegated Authority), reference number HSK/SF/udUH/02387. The propositions arising from this reviewudwill be used to develop recommendations about howudto tailor SDM interventions to older people withudcomplex health and social care needs in an integratedudcare setting.