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BMJ Open. 2017 Feb 7;7(2):e014026. doi: 10.1136/bmjopen-2016-014026.

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

Author information

Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK.
Social Care Workforce Research Unit, King's College London, London, UK.
The Preference Laboratory, The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire, USA.
Tower Hamlets Clinical Commissioning Group, The Tredegar Practice, London, UK.
Research Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus), London, UK.
University of Hertfordshire, Hatfield, UK.
Centre for Health Service Studies, University of Kent, Canterbury, UK.



Including the patient or user perspective is a central organising principle of integrated care. Moreover, there is increasing recognition of the importance of strengthening relationships among patients, carers and practitioners, particularly for individuals receiving substantial health and care support, such as those with long-term or multiple conditions. The overall aims of this synthesis are to provide a context-relevant understanding of how models to facilitate shared decision-making (SDM) might work for older people with multiple health and care needs, and how they might be applied to integrated care models.


The synthesis draws on the principles of realist inquiry, to explain how, in what contexts and for whom, interventions that aim to strengthen SDM among older patients, carers and practitioners are effective. We will use an iterative, stakeholder-driven, three-phase approach. Phase 1: development of programme theory/theories that will be tested through a first scoping of the literature and consultation with key stakeholder groups; phase 2: systematic searches of the evidence to test and develop the theories identified in phase 1; phase 3: validation of programme theory/theories with a purposive sample of participants from phase 1. The synthesis will draw on prevailing theories such as candidacy, self-efficacy, personalisation and coproduction.


Ethics approval for the stakeholder interviews was obtained from the University of Hertfordshire ECDA (Ethics Committee with Delegated Authority), reference number HSK/SF/UH/02387. The propositions arising from this review will be used to develop recommendations about how to tailor SDM interventions to older people with complex health and social care needs in an integrated care setting.


Older people; Shared decision making; long term conditions; multimorbidity; realist synthesis

[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

All authors have completed the ICMJE uniform disclosure form at and declare: Professor Goodman received personal fees from the National Institute for Health Research (NIHR) during the conduct of the study, all others report no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

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