Shared decision-making between older people with multimorbidity and GPs: focus group study

This is the author accepted manuscript. The final version is available from the Royal College of General Practitioners via the DOI in this record. Background: Shared decision-making, utilising the expertise of both patient and clinician, is a key feature of good-quality patient care. Multimorbidity can complicate shared decision-making, yet few studies have explored this dynamic for older patients with multimorbidity in general practice. Aim: To explore factors influencing shared decision-making from the perspectives of older patients with multimorbidity and GPs, to inform improvements in personalised care. Design & setting: Qualitative study. General practices (rural and urban) in Devon, England. Method: Four focus groups, two with patients (aged 65+ with multimorbidity) and two with GPs. Data were coded inductively by two researchers applying thematic analysis. Results: Patient acknowledgement of clinician medicolegal vulnerability in the context of multimorbidity, and their recognition of this as a barrier to shared decision-making, is a new finding. Medicolegal vulnerability was a unifying theme for other reported barriers to shared decision-making. These included expectations for GPs to follow clinical guidelines, challenges encountered in applying guidelines and in communicating clinical uncertainty, and limited clinician self-efficacy for shared decision-making. Increasing consultation duration and improving continuity were viewed as facilitators. Conclusion: Clinician perceptions of medicolegal vulnerability are recognised by both patients and GPs as a barrier to shared decision-making and should be addressed to optimise delivery of personalised care. Greater awareness of multimorbidity guidelines is needed. Educating clinicians in the communication of uncertainty should be a core component of shared decision-making training. The incorrect perception that most clinicians already effectively facilitate shared decision-making should be addressed to improve the uptake of personalised care interventions.National Institute for Health Research (NIHR