Supporting shared decision making for older people with multiple health and social care needs: a realist synthesis to inform emerging models of health and social care

Award Number
Health and Social Care Delivery Research
Status / Stage
2 July 2016 -
1 July 2017
Duration (calculated)
00 years 11 months
Funding Amount
Funder/Grant study page
Contracted Centre
University of Hertfordshire
Principal Investigator
Professor Frances Bunn
PI Contact
WHO Catergories
Methodologies and approaches for risk reduction research
Models across the continuum of care
Disease Type
Dementia (Unspecified)

CPEC Review Info
Reference ID205
ResearcherReside Team


Award Number15/77/25
Status / StageCompleted
Start Date20160702
End Date20170701
Duration (calculated) 00 years 11 months
Funder/Grant study pageNIHR
Contracted CentreUniversity of Hertfordshire
Funding Amount£164,879.62


The overall aim is to 1) Identify key features or mechanisms of programmes and approaches that strengthen relationships between community health and social care providers, patients with multiple health and social care needs, and their family carers, 2) provide a context relevant understanding of how models to facilitate shared decision making might work for older people with multiple health and social care needs, and how they might be applied in the vanguard sites. Given these complexities a realist approach focusing on key programme theories and testing them in different contextual conditions is considered most appropriate. Realist synthesis will be used to identify the theories and the mechanisms, by which the authors of studies explicitly or implicitly assume that interventions to promote shared decision making with patients, and their family carers, work. We propose an iterative stakeholder driven three stage approach that optimises the knowledge and networks of the research team; it will be conducted over 12 months Phase 1: Define scope and develop theories of how interventions work. Consultation with key stakeholder groups and a first search and mapping of the literature will identify why certain approaches to involve patients and their carers in decision making and care planning are thought to work (or not), in what circumstances and why. The project team will hold a one day workshop to review the findings and agree an explanatory model and associated candidate programme theories to guide the next stage of the review process. Phase 2: Retrieval, review and synthesis. This will involve systematic searches of the evidence to test and develop the theories identified in phase 1. An iterative approach to targeting evidence will be used across different databases, and other information sources. Synthesis of the data will involve the organisation of evidence tables and identification of cross cutting themes that either support or negate certain context mechanism-outcome configurations. Findings, including hypotheses on the nature of the context, mechanism and outcome links, and the characteristics of the evidence underpinning them, will be reviewed at a second one-day workshop. Phase 3: Test and refine programme theory/ies (validation). To facilitate the development of a final review narrative and a refined set of hypotheses, we will validate our findings and final narrative from Phase two by testing them, and iteratively refining them, through discussion and review within the team and interviews with a purposive sample of participants from Phase 1. This will help establish their potential, and feasibility of implementation, for older people with complex health and social care needs in a variety of settings. To ensure maximum impact we will draw on our practice, clinical, service provider, and public and patient involvement networks. Outputs will include a final research report, and linked publications. Expertise The proposed synthesis will be carried out by a highly experienced team of multidisciplinary researchers and clinicians who bring to the project expertise in realist synthesis, primary care, social care, patient involvement and the care of older people.


We want to find out how we can improve the way we involve older people, and their family carers, in decisions about their health and social care. We call this approach shared decision making (SDM). In particular we want to find out how SDM can work in community settings where many different health and social care workers (such as GPs, nurses, social carers) may be involved in caring for the older person