BACKGROUND Shared decision making (SDM) contributes to personalized decisions that fit the personal preferences of patients when choosing a treatment for a condition. However, older adults frequently face multiple chronic conditions (MCC). Therefore, implementing SDM requires special features. The aim of this paper is to describe the development of an intervention to improve SDM in older adults with MCC. METHODS Following the Medical Research Council framework for developing complex interventions, the SDMMCC intervention was developed step-wise. Based on a literature review and empirical research in a co-creation process with end users, we developed training for geriatricians and a preparatory tool for older patients with MCC and informal caregivers. After assessing feasibility, the intervention was implemented in a pilot study (N = 108) in two outpatient geriatric clinics of an academic and a non-academic teaching hospital in Amsterdam, the Netherlands. RESULTS Key elements of the training for geriatricians include developing skills to involve older adults with MCC and informal caregivers in SDM and following the six-step 'Dynamic model for SDM with frail older patients', as well as learning how to explore personal goals related to quality of life and how to form a partnership with the patient and the informal caregiver. Key elements of the preparatory tool for patients include an explicit invitation to participate in SDM, nomination that the patient's own knowledge is valuable, invitation to form a partnership with the geriatrician, encouragement to share information about daily and social functioning and exploration of possible goals. Furthermore, the invitation of informal caregivers to share their concerns was also a key element. CONCLUSIONS Through a process of co-creation, both training for geriatricians and a preparatory tool for older adults and their informal caregivers were developed, tailored to the needs of the end users and based on the 'Dynamic model of SDM with frail older patients'.

中文翻译：

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DICO研究开发了基于证据的SDMMCC干预措施，以改善老年患者的共同决策。

背景技术共享决策制定（SDM）有助于个性化决策，这些个性化决策适合患者选择病情治疗时的个人喜好。但是，老年人经常面临多种慢性病（MCC）。因此，实施SDM需要特殊功能。本文的目的是描述一种改善MCC老年人SDM的干预措施。方法遵循医学研究理事会制定复杂干预措施的框架，逐步开发SDMMCC干预措施。在与最终用户共同创建过程中的文献综述和实证研究的基础上，我们开发了针对老年医生的培训以及针对MCC和非正式护理人员的老年患者的准备工具。在评估可行性之后，该干预措施是在荷兰阿姆斯特丹的一家学术和非学术教学医院的两家门诊老年诊所进行的一项初步研究（N = 108）中进行的。结果老年医师培训的关键要素包括发展技能，使具有MCC的老年人和非正式护理人员参与SDM，并遵循六步“针对年老体弱患者的SDM动态模型”，以及学习如何探索与之相关的个人目标生活质量以及如何与患者和非正式护理人员建立伙伴关系。为患者准备的工具的关键要素包括：明确邀请他们参加SDM，提名患者自己的知识很有价值，邀请与老年医生建立合作伙伴关系，鼓励分享有关日常和社交功能的信息，并探讨可能的目标。此外，邀请非正式照料者分享他们的关切也是一个关键因素。结论通过共同创建的过程，针对最终用户的需求，并根据“脆弱的老年患者的SDM动态模型”，开发了针对老年人的培训以及针对老年人及其非正式护理人员的准备工具。