Feasibility testing the intercultural acceptability of a shared decision-making intervention

(Reviewed by PPIE members)
The problem
The number of older people living with more than one health problem is increasing. These people live with a burden of illness and doctors find it challenging to manage their needs. Involving people in decision-making about their care can benefit both patients and doctors. People from different cultures might want to be involved differently. However, there has been little research about how to do this for older people with multiple health problems.
‘VOLITION’ will help people be involved in decision-making and it is currently being produced with the involvement of members of the public. The exact details (see document SPCR_Butterworth_FR12_Protocol, Table 1) may change because the
work is ongoing, but it is likely to include:

Patient information (which could be in a leaflet, text message, or online) to invite patients to tell their GP how much they would like to be involved, with example phrases to use. The information will also invite patients to talk about what
matters most to them in day-to-day life, so that this can be included when sharing decision-making with the GP.

A workshop for GPs, teaching them skills to involve patients, whilst taking account of the pressures that GPs are under.

Training will include taking account of how the patient prefers to be involved in decision-making, asking for what matters most to the patient, sharing where there is uncertainty around a decision to be made, and bringing the patient’s expertise on their life into the decision.

What are we planning?
We are currently working with people from all types of background to produce the VOLITION materials and to plan how to test them in day-to-day practice. The intervention needs testing out with members of the public, to check that our approach
has led to an inclusive intervention that can be used to respond to the needs of people from all backgrounds and cultures. In this study, we will send the patient-facing materials (which may include a leaflet, or an online resource) to twenty people
living with more than one long-term condition, and/or their carers, from different cultural backgrounds. We will interview them to find out whether they think the intervention materials apply to them and whether they find them understandable
and acceptable. We will refine the materials based on the findings from this study.

What next?
In a future study, we will test the whole intervention (both patient-facing materials and GP training workshop) to work out whether it can be delivered and evaluated in day-to-day general practice. We believe that VOLITION has potential to improve patients’ experiences of care and relieve pressures on GPs. Our approach is in line with UK health policy, aiming to improve personalised care.