Engaging older adults in health care decision-making: Key findings and recommendations from the CHOICE knowledge synthesis project

Abstract

Introduction: Engagement in shared health care decision-making has been recognized as an important, and often lacking, aspect of person-centred care. We aimed to draw on available theory, evidence and experience to develop guidelines for engaging older adults and their families in decisions around their own health care. Aims: To share results from the CHOICE (Choosing Healthcare Options by Involving Canada’s Elderly) knowledge synthesis project. Guidelines for engaging older adults and their families in health care decision-making will be presented. Methods: We conducted a realist synthesis (1-2) of available knowledge on strategies for engagement of older patients and their caregivers in health care decision-making. The search methodology was informed by a framework for realist syntheses (3) as well as Arksey and O'Malley’s (4) design considerations for scoping reviews. Our synthesis encompassed theoretical frameworks and both peer-reviewed and grey literature. Search terms included: health care, decision making, public, health care decision making, engagement, and public engagement. Expert consultation included interviews with academics (n=5), two focus group interviews with seniors and families, and two half-day workshops organized with our partner Patients Canada. Results: The initial search generated over 15,000 articles; of these, 2921 were pertinent to health care decision making and were retained for further review. Theoretical and empirical work identifies a range of strategies and levels of engagement of older patients, but offers most support for approaches in which older patients and families are informed and active partners in decisionmaking and equal members of health care teams. Conclusions: We have developed guidelines and recommendations for creating productive partnerships between older adults, their families, and health care providers. These partnerships can result in more informed clinical decisions, and more effective health care. Limitations: Due to the limited information on engagement of older adults (65+), our search strategy included papers focusing on engagement of patients who were over 18 years of age. We held focus groups with older adults to review and interpret the study findings.