Shared decision making between older people with multimorbidity and GPs: a qualitative study

The British journal of general practice: the journal of the Royal College of General Practitioners

article

Emily L Brown¹  Leon Poltawski¹  Emma Pitchforth¹  Suzanne H Richards²  John L Campbell¹  Joanne E Butterworth¹ 

[1] National Institute for Health Research doctoral research fellow and GP, Exeter Collaboration for Academic Primary Care, College of Medicine and Health, University of Exeter;Division of Primary Care, Palliative Care and Public Health, Faculty of Medicine and Health, University of Leeds, Leeds Institute of Health Sciences

关键词: general practice;    multimorbidity;    aged;    shared decision making;    qualitative research;   

DOI  :  10.3399/BJGP.2021.0529

学科分类：卫生学

来源: Royal College of General Practitioners

【 摘 要 】

Background Shared decision making (SDM), utilising the expertise of both patient and clinician, is a key feature of good-quality patient care. Multimorbidity can complicate SDM, yet few studies have explored this dynamic for older patients with multimorbidity in general practice.Aim To explore factors influencing SDM from the perspectives of older patients with multimorbidity and GPs, to inform improvements in personalised care.Design and setting Qualitative study. General practices (rural and urban) in Devon, England.Method Four focus groups: two with patients (aged ≥65 years with multimorbidity) and two with GPs. Data were coded inductively by applying thematic analysis.Results Patient acknowledgement of clinician medicolegal vulnerability in the context of multimorbidity, and their recognition of this as a barrier to SDM, is a new finding. Medicolegal vulnerability was a unifying theme for other reported barriers to SDM. These included expectations for GPs to follow clinical guidelines, challenges encountered in applying guidelines and in communicating clinical uncertainty, and limited clinician self-efficacy for SDM. Increasing consultation duration and improving continuity were viewed as facilitators.Conclusion Clinician perceptions of medicolegal vulnerability are recognised by both patients and GPs as a barrier to SDM and should be addressed to optimise delivery of personalised care. Greater awareness of multimorbidity guidelines is needed. Educating clinicians in the communication of uncertainty should be a core component of SDM training. The incorrect perception that most clinicians already effectively facilitate SDM should be addressed to improve the uptake of personalised care interventions.

【 授权许可】

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