Effects of a shared decision making intervention for older adults with multiple chronic conditions; the DICO study

Background: To evaluate the effects of a shared decision making (SDM) intervention for older adults with multiple chronic conditions (MCCs). Methods: A pragmatic trial evaluated the effects of the SDM training for geriatricians and a preparatory tool for patients. From two outpatient geriatric clinics 216 patients with MCCs participated. Researchers observed SDM using the OPTION MCC tool during video-recorded consultations, and patient- and caregivers reported outcomes regarding patient participation, perceived SDM and decisional conflict. A mixed model analysis was used to assess the level of observed SDM. Patient participation and decisional conflicts were analyzed with a logistic mixed model. Results: : The mean age was 77.3 years, and 56.3% of patients were female. No significant difference was found in the overall level of SDM as measured with the OPTION MCC or in the patient-reported outcomes. However, at item level the items discussing ‘goals’, ‘options’, and ‘decision making’ significantly improved after the intervention. The items discussing ‘partnership’ and ‘evaluating the decision-making process’ showed a significant decrease. 52% of the patients completed the preparatory tool, but the results were only discussed in 12% of the consultations. Conclusions: : This study provides scope for improvement of SDM in geriatrics. Engaging older adults with MCCs and informal caregivers in the decision making process should be an essential part of SDM training for geriatricians, beyond the SDM steps of explaining options, benefits and harms. Furthermore, more attention should be paid to the integration of preparatory tools in the consultation.