Development of a patient decision aid regarding aspects of oral health in a home care context

Background Oral health is a fundamental component of healthy ageing. Older adults receiving home care are at high risk of poor oral health and often have limited opportunities to participate in decisions affecting their oral health, despite strong links between oral health, autonomy and quality of life. While shared decision-making (SDM) is increasingly emphasised in health care, patient decision aids (PtDAs) addressing oral health decisions in home-care settings are lacking. This study aimed to describe the iterative development of a PtDA designed to support oral health decision-making among older adults receiving home care. Methods Guided by the International Patient Decision Aid Standards (IPDAS) development model, the PtDA was developed through three phases: understanding users, developing and refining the tool, and assessment. A co-design approach was applied throughout. Data were collected through interviews, living labs and workshops involving older adults, municipal home-care staff, dental professionals, leaders, and system developers. Results A PtDA was developed to facilitate SDM regarding oral health in home care contexts. The tool was informed by the Ottawa Decision Support Framework (ODSF) and IPDAS principles. Four key decisional needs were identified: holistic information, clarity of roles, support for, and preservation of existing routines. Living labs revealed two recurrent decision points during cross-organisational oral assessments: decisions regarding dental care (type, location, or deferral) and decisions regarding support for daily oral hygiene. These insights informed a PtDA integrating subjective oral health assessments, Revised Oral Assessment Guide (ROAG) findings, values clarification, and structured deliberation guidance. The PtDA fulfilled all IPDAS qualifying and essential criteria. Conclusions The study presents the development of an evidence-informed, co-designed PtDA for oral health in a home-care context. Embedded within a digital, cross-organisational oral-health platform, the PtDA supports older adults’ involvement in oral health decisions, enhances communication across care providers, and aligns with established standards for SDM.