Developing an integrated model for person-centered shared decision-making in older adults with multiple chronic conditions: a Delphi study

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Background The global increase in life expectancy has resulted in a growing population of older adults living with multiple chronic conditions, which presents significant challenges for healthcare systems. They often experience decline in independence, increased treatment burdens, and reduced quality of life. Existing person-centered shared decision-making models have limitations, such as focusing primarily on medical care and neglecting the involvement of multidisciplinary teams, informal caregivers, and preparation on person-centered shared decision-making for patients. This study aimed to develop an advanced, integrated person-centered shared decision-making model tailored to older adults with multiple chronic conditions. Methods A three-step Delphi methodology was used to design and refine the person-centered shared decision-making model. In the first step, empirical data from healthcare professionals across 20 geriatric hospital wards and 22 general practices in the Netherlands were collected to identify gaps in existing models. In the second step, an expert panel of 33 healthcare professionals and shared decision-making researchers reviewed and provided feedback on the proposed model through a digital survey. In the third step, the revised model was distributed to 94 healthcare professionals for further feedback. Consensus was achieved when at least 75% of participants agreed on each element of the model. Results The final model received strong support, with over 75% agreement on all key elements from both the expert panel and the broader healthcare community. Key revisions included adding a “Team Talk” step to clarify professional roles, expanding “Option Talk” to include both healthcare provider options and those the patient or informal caregivers can manage independently, and developing preparatory tools for patients and caregivers. Feedback highlighted the need for role clarity, interdisciplinary training, and tools for patients with low health literacy. Conclusions The integrated person-centered shared decision-making model provides a comprehensive framework for person-centered decision-making in the care of older adults with multiple chronic conditions. The model supports interdisciplinary collaboration, emphasizes patient and caregiver preparation, and addresses key gaps in current shared decision-making approaches. Future research should focus on evaluating its real-world application and developing effective implementation strategies. Trial registration Not applicable for this study.