Table 4 Overview of four Context-Mechanism-Outcome configurations that make up the programme theory

CMO1 Reflecting patient and carer values: Systems that enable HSCPs to develop relationships with patients and carers, and with each other, and that allow them to understand and assess individual needs and patient and carer capacity to access and use care, will activate trust and engagement leading to better outcomes for patients and carers.

[30, 31, 47, 50, 51, 53, 56, 59, 63, 65, 67], [41, 72,73,74, 77, 80,81,82,83, 87, 90, 91, 93, 94, 96,97,98, 100,101,102,103,104,105,106, 109, 110, 113, 117,118,119,120,121, 124, 128]

CMO2: Systems that are organised to support and prioritise SDM will lead to HSCPs feeling supported (and equipped) to engage in SDM resulting in SDM becoming part of the culture of care.

[30, 31, 53, 56] [8, 14, 80,81,82, 85, 86, 96, 106, 121] [74, 83, 87, 103, 104, 110, 122, 124, 128] See

CMO3: People with complex health and care needs, and their family carers, are likely to need support, such as appropriate decision tools, and space and time to ask questions and discuss options, in order for them to be willing and able to participate in SDM.

[48, 49, 54, 58, 61, 62, 68, 69] [8, 14, 70, 84,85,86, 92, 95, 96, 107, 108, 113, 117, 118, 121] [83, 89, 90, 94, 125] [75, 76, 99, 129] [63]

CMO 4: SDM as part of a wider cultural change (e.g. family centred approaches, changes in power dynamics and patients and carers taking (or sharing) responsibility for their health and the decisions which affect them), triggers the development of a shared expectation of (and familiarity with) SDM amongst patients, carers and HSCPs leading to improved patient outcomes.

[60, 62, 65, 68] [49] [50, 53] [8, 14, 82, 87, 96, 121, 122]