Perspectives on shared decision making related to medications from patients with multiple long- term conditions transitioning from hospital to home: a qualitative study

Introduction Persons with multiple long-term conditions (MLTCs) are often reliant on complex medication regimens where decisions surrounding medications are frequent and shared decision making (SDM) is beneficial. Aim The aim was to explore the perspectives of patients with MLTCs regarding SDM related to medications before, during and after a hospital stay. Method Semi-structured interviews with 21 patients and 3 next of kin were conducted. Normally home-dwelling patients ≥ 18 years with MLTCs, using a minimum of 4 medications for a minimum of 2 separate conditions were included from two geriatric wards and one internal medicine ward at a university hospital in Norway, and interviewed approximately 14 days post hospital discharge. The qualitative data was analyzed according to the three-talk model, by Elwyn et.al. 2017. Results Patients reported a lack of invitation from HCPs to be part of the SDM process. Patients perceived their limited medical knowledge as a barrier that prevented HCPs from inviting them to participate in SDM. They reflected on themselves being primarily focused on single details regarding one medication option they had received. Furthermore, they were not encouraged to discuss several options by HCPs. Participants experienced how decisions being made by HCPs were expected to be accepted although the patient did not necessarily understand the treatment adequately. Although most patients trusted HCPs to act in their best interests, this reliance resulted in further disengagement from their own treatment. Conclusion Our findings revealed that patients were in general unfamiliar with SDM related to medications. Additionally, the participants reflected on a lack of invitation to team talk which resulted in limited patient involvement both in option and decision talk.