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Table 3 Recommendations generated from stakeholder consultations

From: Preferences and priorities to manage clinical uncertainty for older people with frailty and multimorbidity: a discrete choice experiment and stakeholder consultations

Question 1: What are the key characteristics of tools for clinical practice to enhance care processes of comprehensive assessment, communication with families and continuity of care between hospital and home (or care home)?

Recommendations:

Group top priority (n)

Participant top priority (n)

R1: The tool needs to be comprehensive by considering social, physical and psychosocial health domains and record contextual information on the patient journey, such as admitted from, home environment, such as lives alone, and who’s important to the patient.

1

16

R2: The tool can be understood and interpreted by all staff, patients and family to support understanding on different roles on using the tool in clinical care.

0

16

R3: The tool is relevant for the population and context that used with. The tool has demonstrated value to improve care processes and outcomes.

2

11

R4: The tool is simple, clear and concise to complete and interpret.

2

11

R5: The tool is person-centred. The tool records goals and preferences and priorities for care as discussed with the patient and/or family, such as in the ‘Welcome meeting’ on admission with the patient and/or family

2

9

R6: The tool Is used across care settings and travels with the patient at points of transition in care. This provides a common language between care settings and services to share information succinctly about clinical condition, such as frailty level, symptoms and concerns, and patient priorities

0

5

R7: The tool is standardised for use nationally. This will support transitions between settings by providing a common language and enable national benchmarking of services to evaluate care processes and outcomes.

2

4

R8: The tool is evidence-based, valid and reliable.

1

4

R9: The tool fits in routine care and minimises duplicating existing care processes.

1

4

R10: The tool is adaptable, able to tailor to the person, context and setting.

1

4

R11: The tool can be repeated overtime to monitor and review change in clinical presentation, such as frailty level at baseline on admission and at discharge.

0

4

R12: The tool is sensitive to change in the patient’s symptoms and concerns and can be used across conditions.

0

3

R13: The tool supports communication with the family about care, treatment, and anticipated outcomes, and fosters engagement in care processes, such as discharge planning.

1

2

Question 2: How can we enable staff to use tools in clinical practice to enhance care processes of comprehensive assessment, communication with families and continuity of care between hospital and home (or care home)?

Recommendations:

Group top priority (n)

Participant top priority (n)

R14: Delivering training and ongoing support to use the tool in clinical care using multiple methods. Methods include in-service training with peer support, champions and leaders, and eLearning with supportive materials such as templates and case studies. Training is tailored for the respective level of responsibility, such as health care assistants and registered staff.

3

30

R15: Staff have ownership of the tools used in clinical care. Staff understand the meaning, relevance and clinical importance of the tool, how use enhances clinical care and benefits patient. Staff understand their respective role and feel empowered using the tool to improve clinical care and patient outcomes.

2

20

R16: The tool is simple, clear and concise to use and interpret in clinical care. This makes it easy to use and easy to insert in assessments tailored to the individual. It is clear how the tools is completed, by which discipline(s), which components and when. The tool is completed in the electronic patient record to support communication within the clinical team, and across services with integrated record systems, such as to view health records.

2

16

R17: Time and physical space is provided for staff to complete tools with the patient and/or family, record on the electronic patient record and review with the multi-disciplinary team.

1

4

R18: Staff can pilot using the tool and feedback on what works, and changes needed before implementation in clinical care.

0

3

R19: Service evaluation on the processes and outcomes of using the tool, such as audit on completion. Findings are fed back to staff to build confidence, see the value of the tool for patient care and sustain use.

0

3

R20: The tool respects staff experience, knowledge and skills.

1

1