Abstract
BackgroundPersonalised care planning (PCP) interventions have the potential to provide better outcomes for older people and are a key focus in primary care practice. Behaviour change techniques (BCTs) can maximise effectiveness of such interventions, but it is uncertain which BCTs are most appropriate in PCP for older adults.AimTo identify BCTs used in successful PCP interventions for older people aged ≥65 years.Design and settingSystematic review.MethodThe authors searched 12 databases from date of inception to 30 September 2017. They identified randomised controlled trials (RCTs) of interventions involving participants aged ≥65 years, and contextually related to PCP. Five areas of risk of bias were assessed. The Michie et al, BCT taxonomy was used for coding.ResultsTwenty-three RCTs involving 6489 participants (average age 74 years) described PCP interventions targeting the general older adult population and older people with specific long-term conditions (for example, heart disease, diabetes, stroke). Just over half of the studies were deemed to be at a low risk of bias. Eleven ‘promising’ BCTs were identified in five trials reporting significant improvements in quality of life (QoL). Six BCTs were reported in all five of these trials: ‘goal setting’, ‘action planning’, ‘problem solving’, ‘social support’, ‘instructions on how to perform a behaviour’, and ‘information on health consequences’. Modes of delivery varied.ConclusionFuture PCP interventions to improve QoL for people aged ≥65 years may benefit from focusing on six specific BCTs. Better reporting of BCTs would enhance future design and implementation of such interventions.
Highlights
Personalised care planning (PCP), defined as ‘Explicitly engaging patients in a shared decision-making process involving both goal setting and action planning’,1 embodies core principles of ‘person centredness’ and ‘shared decision making’ embedded in the NHS for the past 20 years.[2,3,4,5,6] The aim of PCP is to support individuals to self-manage their own health and wellbeing, typically using behaviour change techniques (BCTs) to help achieve collaborative outcomes
Eleven ‘promising’ Behaviour change techniques (BCTs) were identified in five trials reporting significant improvements in quality of life (QoL)
Future PCP interventions to improve QoL for people aged ≥65 years may benefit from focusing on six specific BCTs
Summary
Personalised care planning (PCP), defined as ‘Explicitly engaging patients in a shared decision-making process involving both goal setting and action planning’,1 embodies core principles of ‘person centredness’ and ‘shared decision making’ embedded in the NHS for the past 20 years.[2,3,4,5,6] The aim of PCP is to support individuals to self-manage their own health and wellbeing, typically using behaviour change techniques (BCTs) to help achieve collaborative outcomes. In the UK, the publication in 2018 of the Comprehensive Model of Personalised Care consolidated evidence demonstrating PCP as a promising approach to achieve change (Figure 1).[7] This informed the 2019 NHS Long Term Plan, and the linked work programme to implement personalised care nationally.[8] As part of the NHS Long Term Plan, the NHS England Ageing Well programme specifies a multidisciplinary team approach to care for older people (generally defined as ≥65 years) defined as anticipatory care Both personalised and anticipatory care were included in the draft 2020 primary care network direct enhanced service (PCN DES) specifications, but implementation was paused after the initial consultation period.[9] Personalised care plans for people eligible for anticipatory care — for example, those with frailty — establish linkage across the individual specifications that are expected to form part of future GP contract negotiations. Behaviour change techniques (BCTs) can maximise effectiveness of such interventions, but it is uncertain which BCTs are most appropriate in PCP for older adults
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