Development of a new intervention (VOLITION): To facilitate the inVolvement of OLder people living with multiple long-term condITions in decisION-making about their healthcare during general practice consultations

Abstract

Introduction

The population is ageing and two thirds of older people in the UK have multiple long-term health problems. These patients consult with GPs frequently. They live with a burden of illness and treatments, poor quality of life and associated healthcare costs. Ensuring high-quality personalised care for these patients is challenging. Potential benefits of shared decision-making (SDM) have been acknowledged. However, there are few existing interventions designed with the aim of facilitating SDM in this field.

Aim

The aim of VOLITION is to facilitate the involvement of older people living with multiple long-term conditions in decision-making about their healthcare during UK general practice consultations.

Methods

An Intervention Mapping (IM) framework was adopted as a means of systematically applying existing literature, new data and relevant theory in the development, refinement and planning for the evaluation of VOLITION.

Patient and public involvement was central and expert stakeholder opinion was obtained. A Cochrane review of similar interventions was published, and VOLITION components were subsequently drafted. Focus groups with patients and GPs enabled the refinement of behaviour-change objectives. A mixed-methods exploratory-explanatory study informed plans to implement VOLITION in the context of remote vs. face-to-face consultations.

Findings

VOLITION consists of i) a prompt to patients, inviting them to express their personal preferences for involvement and ii) training for GPs, delivering a responsive patient-tailored approach to SDM, tackling challenges experienced by GPs when implementing SDM in practice.

Discussion

This project addresses recommendations from the UK National Institute for Health and Care Excellence, for SDM research targeting patient groups who often believe in the decisional authority of the health care practitioner. VOLITION adheres to NHS England’s universal personalised care plan, to empower patients in the management of their healthcare and to train health care practitioners in SDM.

Conclusion

A full, definitive trial of VOLITION is planned. An effective intervention, designed using end-user perspectives, has the potential to influence high-quality patient-centred care for older people living with MLTC.