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Table 1 Preliminary programme theory in the form of if-then statements

From: Supporting shared decision making for older people with multiple health and social care needs: a realist synthesis

Title

If

then

Outcome

Reflecting patient and carer values

If health care professionals (HCPs) place less emphasis on ‘fixing people’ and more on patients’ goals, and emotional, cultural & cognitive needs

Patients and their carers will feel valued and listened to

Patient and their family carer feel involved in the decision and satisfied with the outcome

Preparing (patients and carers) for the SDM encounter

If older people with complex health and social care needs are supported to participate in SDM

Patients and their family carers will feel empowered

The patient and family carers are willing and able to participate in SDM

Sharing the communication of a decision

If HSCPs are familiar with each other’s expertise, roles and responsibilities, and systems facilitate communication between individuals

Professionals will work better together and are less likely to undermine each other

Once a decision has been made by the patient and a health care professional it will be shared across the MDT/agencies

Fake vs real SDM

If systems are organised to support and prioritise SDM

SDM is not just seen as a ‘tick box’ exercise by health care professionals

SDM is authentic not tokenistic

Reducing the workload (for patients and carers)

If HSCPs use appropriate SDM techniques to regularly discuss the clinical value and effectiveness of proposed treatments or interventions

This leads to reduction in inappropriate clinical activity

Reduced treatment burden

  1. * = truncation symbol