Goal setting is insufficiently recognised as an essential part of shared decision-making in the complex care of older patients: a framework analysis

Table 3 Categorisation matrix for SDM with older patients with multimorbidity

	GP_01	CG_02	CG_03	GP_04	CG_05	GP_06	CG_07	CG_08	GP_09	GP_10	CG_11	CG_12	GP_13	CG_14	GP_15	CG_16	CG_17	CG_18	CG_19	GP_20	GP_21	CG_22	GP_23	GP_24	CG_25	GP_26	GP_27	GP_28	CG_29	CG_30	GP_31	CG_32	CG_33
Essential elements
Define/explain problem				x	x							x							x				x			x		x		x		x	x
Present options			x			x		x	x		x	x		x			x											x		x		x
Discuss pros/cons^a					x		x	x	x		x						x									x		x
Patient values/preferences	x		x	x	x		x	x	x	x			x	x		x					x	x				x		x	x	x
Discuss patient ability/self-efficacy				x
Doctor knowledge^b	x		x	x	x	x	x	x		x		x	x	x		x						x				x		x	x	x		x	x
Check/clarify understanding									x	x			x
Make or explicitly defer decision						x			x	x	x	x	x		x		x	x	x		x	x	x	x	x	x		x		x		x
Arrange follow-up					x																				x
Ideal elements
Unbiased information			x		x																	x
Define roles ^c
Present evidence										x
Mutual agreement						x			x	x					x		x		x	x	x						x
General qualities
Deliberation/negotiation				x			x					x	x	x	x					x			x			x		x	x
Flexibility ^d				x	x						x	x						x
Information exchange							x							x
Involves at least two people
Middle ground
Mutual respect													x
Partnership		x		x														x	x	x			x		x				x			x	x
Patient education
Patient participation		x							x	x	x		x			x	x				x	x		x					x
Process/stages	x
Goals and/or goal-setting		x	x	x	x		x				x	x				x		x	x	x					x		x		x		x	x

Note: This table shows the categorisation matrix and results per clinician. The integrative model of shared decision-making of Makoul and Clayman [18] completed with the additional element goals and/or goal-setting was used as categorisation matrix. At the horizontal axis the interviewees are shown, with GP referring to a general practitioner and CG to clinical geriatrician. The vertical axis shows the essential elements, ideal elements, general qualities and the additional element goals and/or goal-setting. Essential elements are elements being conditional for the process of SDM. Ideal elements may enhance the experience of SDM, but relevance, necessity and applicability are dependent on the type of encounter. General qualities are useful in providing an overall sense of SDM, but are not reducible to specific behavior
^a/benefits/risks/costs
^b and recommendations
^cand desire for involvement
^d/individualised approach/cyclical

ISSN: 2731-4553