# Mixed methods realist evaluation of a co-designed intervention to promote shared decision-making with frail older adults, planning discharge from hospital: a protocol

## TL;DR

This study aims to co-design and test an intervention to improve shared decision-making for frail older adults planning hospital discharge, using realist methods to evaluate its feasibility.

## Contribution

The novel aspect is the use of a co-designed, multi-component intervention and realist evaluation to address shared decision-making in frail older adults.

## Key findings

- A three-stage approach will co-design and evaluate a shared decision-making intervention for hospital discharge planning.
- The study will use realist methods to refine program theory and assess feasibility in a Northern Ireland healthcare setting.
- The Quintuple Aim framework will guide outcome evaluation, focusing on health equity, patient experience, and professional well-being.

## Abstract

Effective planning for hospital discharge can best be achieved through shared decision-making (SDM): providing tailored, person-centred, strengths-based choice to allow for individuals to make fully informed decisions, with input from their relatives if they wish. Decisions such as care management, emergency planning and caregiver involvement. However, SDM is challenging for healthcare professionals and patients, particularly older people living with frailty. There is currently no consensus on the optimum way to achieve SDM, as the quality of evidence for interventions is minimal.

This protocol outlines a project that aims to co-design a multi-component intervention to prepare health professionals, patients, and patients’ carers to engage in SDM and to evaluate the feasibility of implementing the intervention using realist methods.

The research will be conducted in a health and social care trust in Northern Ireland with frail, older adults who are planning their discharge from hospital. The project will proceed in three stages. (1) Realist review of the literature will enable formulation of initial programme theory, including the impact of context and the identification of uncertainties. (2) Co-design of the intervention will ensure the inclusion of diverse stakeholders in the development of the intervention, with further development of the programme theory. (3) Implementation and feasibility testing of implementation processes, measurement of intervention costs, testing of outcome measures, and refinement of the programme theory.

In line with MRC guidance for complex interventions we will seek insights to help refine the SDM intervention. The overall outcome evaluation will be guided by the ‘Quintuple Aim’ framework, which has five aims of seeking to advance health equity, enhance patient experience, improve health, reduce costs, and improve the work life of healthcare professionals.

(International Prospective Register of Systematic Reviews) registration number CRD42024541455.

Not applicable.