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

Area of Science:

• General Practice
• Qualitative Research
• Patient Care

Background:

• Shared decision making (SDM) is crucial for quality patient care.
• Multimorbidity presents unique challenges to SDM, particularly for older adults in general practice settings.
• Limited research exists on SDM dynamics in older patients with multimorbidity.

Purpose of the Study:

• To investigate factors influencing SDM from the viewpoints of older patients with multimorbidity and their General Practitioners (GPs).
• To provide insights for enhancing personalized care delivery.

Main Methods:

• A qualitative study was conducted in rural and urban general practices in Devon, England.
• Data were collected through four focus groups: two with patients (aged ≥65 with multimorbidity) and two with GPs.
• Inductive coding and thematic analysis were applied to the collected data.

Main Results:

• A novel finding is patient recognition of clinician medicolegal vulnerability as a barrier to SDM.
• Medicolegal vulnerability unified other barriers, including adherence to clinical guidelines, communication of uncertainty, and clinician self-efficacy.
• Increased consultation time and continuity of care were identified as facilitators for SDM.

Conclusions:

• Clinician perceptions of medicolegal vulnerability are a significant barrier to SDM, recognized by both patients and GPs.
• Addressing medicolegal concerns and improving awareness of multimorbidity guidelines are essential for personalized care.
• SDM training should emphasize communication of uncertainty, and the misconception of current SDM effectiveness needs correction.