A qualitative focus group study to refine a new intervention 'VOLITION': To facilitate the involvement of older patients with multimorbidity in decision-making about their healthcare during GP consultations.

Problem

In the UK, the number of people aged over 65 years is increasing. Over a third of spending in general practice goes towards care for older patients. They are likely to have more than one long-term health problem (multimorbidity) and these patients tend to have a poorer quality of life.Sharing in decision-making with a doctor can have positive health outcomes including taking the doctor's advice about treatments, feeling happier about the care received, and having trust in the doctor. Despite older patients with multimorbidity reportedly valuing the opportunity to share in decision-making about their healthcare, they are currently less often involved when compared with younger patients.This study uses qualitative methods to refine a new intervention ‘VOLITION’ ahead of testing the intervention in a randomised controlled feasibility trial. VOLITION aims to support older patients with multiple health problems in joint decision-making about their healthcare during GP consultations.

Approach

Focus groups will compare common views on the proposed intervention, ‘VOLITION’, which consists of: • a half-day training workshop for GPs in shared decision-making• a written involvement-facilitating tool for patients (delivered by post and available in the waiting room). We are recruiting 20 patients and 15 GPs from five practices across Devon. Practices have been purposively selected based on sociodemographic characteristics, in order to achieve diversity in our sample. Patients, aged 65 years and over with more than one long-term health problem, are approached via a mail-out from practices. On return of questionnaires, those with varying degrees of morbidity are invited to participate. All GPs from the practice are invited. There are four focus groups, each lasting 2.5 hours; two with approximately ten patients and two with seven or eight GPs. Topic guides aid exploration of all aspects regarding the development and refinement of the intervention.Focus groups are audio-recorded, transcribed, anonymised and analysed with the aid of computer software. As we have multiple focus groups the constant comparative technique will be used, following a deductive framework and coding inductively for thematic analysis.

Findings

This study is currently in progress, however findings will be available to present at the conference. We will use the analysis to fine tune our intervention materials ahead of testing them in a feasibility trial.

Consequences

Interventions aimed at facilitating shared decision-making between doctors and patients are outdated in their assessments of today’s older patient population, who often experience multimorbidity. These patients need support in prioritising treatment options in order to maximise quality of life and day-to-day function. We believe that an effective intervention in this area could address health inequalities, with positive outcomes for both patients and practitioners, thereby reducing primary healthcare costs for the NHS.