Thesis Defense Ruth Pel-Littel – Shared decision making for older patients and their caregivers

Published on November 11, 2020 – Ask older adults and their informal caregivers to think at home about what they themselves find important to discuss with the doctor, and explicitly invite them to bring their knowledge and experience about their personal life with diseases into the conversation with the doctor.

On Friday 20 November Ruth Pel-Littel will defend her thesis “Shifting from “What is the matter?” to “What matters to you?”. Shared decision making for older adults with multiple chronic conditions and their informal caregivers”. This research explores how older adults with multiple chronic conditions and their informal caregivers can be better involved in shared decision making on treatment and care. A preparation leaflet and a training course for physicians were developed. The results of this research show that for older adults personal health outcomes such as quality of life, independence and social contacts are often more important than disease-specific outcomes. Their knowledge and experience about their personal life with chronic diseases helps them to discuss preferences during consultation. The preparation leaflet supports older patients and their informal caregivers to gain insight into this. As a result of the training, geriatricians are better able to discuss the personal goals of older adults and also explain the various treatment options with benefits and harms. However, it remains a challenge to actively involve older adults in the conversation. However, especially with older people with lower health literacy, shared decision making has a positive effect on how confident older adults feel about the decision.

The preparation leaflet for older adults and their caregivers and the training for physicians are now being further developed and implemented at the geriatric outpatient clinics of various hospitals. The Dutch Association for Clinical Geriatrics (NVKG) has the ambition to implement shared decision making together with personal outcome measures in all geriatric departments in the Netherlands. For this rollout, a team of researchers and advisors from Vilans works together with the NVKG and senior citizens’ organization KBO-PCOB.

The research was a collaboration between the Department of Elderly Medicine of the AMC, Vilans, ACHIEVE knowledge center of the Hogeschool van Amsterdam, the Department of Communication Science of the University of Amsterdam and Tilburg University.

Ruth Pel-Littel was supervised by ACHC professor dr. Julia van Weert (UvA), prof. dr. Bianca Buurman (AMC-UvA), prof. dr. Wilma Scholte op Reimer (AMC-UvA)  en prof. dr. Mirella Minkman (Tilburg University).

Vilans and ZonMw financed the research.

The PhD thesis can be viewed online here.

The defense can be viewed online (in Dutch) here.

Click here for the Observer OptionMCC score sheet to observe triadic shared decision making with older patients with multiple chronic diseases and their caregivers based on videorecordings.