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Supporting shared decision-making for older people with multiple health and social care needs: a protocol for a realist synthesis to inform integrated care models
  1. Frances Bunn1,
  2. Claire Goodman1,
  3. Jill Manthorpe2,
  4. Marie-Anne Durand3,
  5. Isabel Hodkinson4,
  6. Greta Rait5,
  7. Paul Millac6,
  8. Sue L Davies1,
  9. Bridget Russell1,
  10. Patricia Wilson7
  1. 1Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
  2. 2Social Care Workforce Research Unit, King's College London, London, UK
  3. 3The Preference Laboratory, The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire, USA
  4. 4Tower Hamlets Clinical Commissioning Group, The Tredegar Practice, London, UK
  5. 5Research Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus), London, UK
  6. 6University of Hertfordshire, Hatfield, UK
  7. 7Centre for Health Service Studies, University of Kent, Canterbury, UK
  1. Correspondence to Dr Frances Bunn; f.bunn{at}


Introduction Including the patient or user perspective is a central organising principle of integrated care. Moreover, there is increasing recognition of the importance of strengthening relationships among patients, carers and practitioners, particularly for individuals receiving substantial health and care support, such as those with long-term or multiple conditions. The overall aims of this synthesis are to provide a context-relevant understanding of how models to facilitate shared decision-making (SDM) might work for older people with multiple health and care needs, and how they might be applied to integrated care models.

Methods and analysis The synthesis draws on the principles of realist inquiry, to explain how, in what contexts and for whom, interventions that aim to strengthen SDM among older patients, carers and practitioners are effective. We will use an iterative, stakeholder-driven, three-phase approach. Phase 1: development of programme theory/theories that will be tested through a first scoping of the literature and consultation with key stakeholder groups; phase 2: systematic searches of the evidence to test and develop the theories identified in phase 1; phase 3: validation of programme theory/theories with a purposive sample of participants from phase 1. The synthesis will draw on prevailing theories such as candidacy, self-efficacy, personalisation and coproduction.

Ethics and dissemination Ethics approval for the stakeholder interviews was obtained from the University of Hertfordshire ECDA (Ethics Committee with Delegated Authority), reference number HSK/SF/UH/02387. The propositions arising from this review will be used to develop recommendations about how to tailor SDM interventions to older people with complex health and social care needs in an integrated care setting.

  • Shared decision making
  • Older people
  • long term conditions
  • multimorbidity
  • realist synthesis

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  • Twitter Follow Frances Bunn @bunn_f

  • Contributors FB is responsible for the initial drafting of the manuscript. CG provided contributions on methodology. IH, JM, PM, GR, PW and M-AD provided subject expertise. All authors were involved in the protocol design, critically reviewed the paper and gave final approval of the version to be published.

  • Funding This article presents independent research commissioned by the National Institute for Health Research (NIHR) under HS&DR (grant reference number 15/77/25).

  • Disclaimer The views expressed in this paper are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. The sponsor of the study had no role in study design or writing of the paper.

  • Competing interests All authors have completed the ICMJE uniform disclosure form at and declare: Professor Goodman received personal fees from the National Institute for Health Research (NIHR) during the conduct of the study, all others report no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethics approval Approvals have been obtained from the University of Hertfordshire ECDA (Ethics Committee with Delegated Authority), reference number HSK/SF/UH/02387.

  • Provenance and peer review Not commissioned; externally peer reviewed.