Table 1 Results of Phase I

Step

Aim

Results

Intervention

A: for training

B: for preparatory tool

1

To identify barriers and facilitators to SDM with older adults with MCC

Main barriers:

1. Personal patient characteristics such as being in poor health and/or having cognitive or physical impairments.

1. Tailor information to capacity of patient, discuss decision capacity/needs (A)

2. Feeling no permission to participate in SDM

2. Explicit invitation to participate in SDM: The doctor has medical knowledge - you have knowledge of your personal situation - together, we can decide what is best for you! (AB)

3. Health professionals with poor interpersonal skills, organizational barriers as time pressure and high turnover of patients.

3. Good patient preparation before consultation enables moving more quickly to the important points of discussion (A)

Main facilitators:

1. The patient’s experiences of living with chronic health conditions

1. Appraisal of personal experiences of patients (A)

2. The assistance of informal caregivers in decision support.

2. Involvement of informal caregiver in SDM by recognizing their contribution in care and inquiring about their concerns (AB)

3. An individualized approach where health professionals seek patient’s preferences.

3. Take personal goals into account by asking them what must happen to improve their quality of life (AB)

To investigate the personal views on the ageing process communicated by older persons

1. Acceptance of ageing, (further) deterioration and worries about limitations and family were important themes on the ageing process communicated by older persons.

1.1 Facilitation of discussion about ‘what matters to you’ by asking them what must happen to improve their quality of life (AB)

1.2 Discuss personal goals that contribute to quality of life (A)

To explore what domains of health are important to discuss with a health professional, according to older adults in the Netherlands

1. The domains older adults gained consensus on were:

1.1 Address in goal talk these topics

(AB)

1.2 Explore impact of MCC on daily life (A)

- functional limitations

- emotional wellbeing

- social functioning

- quality of life

- coping with stress

- dealing with chronic health conditions and the effects of them on daily life

1. Which decisions face older adults with MCC and their informal caregivers during geriatric visits to the hospital?

1. Main decisions are

1) Share that there are often more options (A)

- Additional diagnostics

- Medication

- Follow-up

- Referral to primary care (case manager, GP, physiotherapist, psychologist)

2. What is the preferred and perceived role and participation in SDM for older adults with MCC and their informal caregivers?

2. Main roles in decision making were for patients: ‘triadic decision making’ 41%<> 33% (preferred <> perceived), and for informal caregivers: ‘triadic decision making’ 71%<> 55% (preferred <> perceived). Preferred and perceived participation was for patients 6.6<> 5.1, for informal caregivers 7<> 5.

2. Discuss how older adults with MCC and informal caregivers want to be involved in decision making. Involve them according to their preferences. (A)

3. To what extent are steps of the SDM process operationalized by geriatricians during geriatric consultations [15]?

3 The OPTION^MCC score was 42.5 (0–100), items about ‘team talk’ and ‘evaluation’ scored the lowest (resp. 31 & 36.5).

3. Train geriatricians in team talk and evaluation phase in the process of SDM. (A)