Table 2 The VOLITION intervention applications

Central image

Delivery and facilitation by a GP

Illustrates the spectrum of patient preferences for involvement and poses the question “where do you see yourself?”

For the purposes of role-modelling as a means of knowledge transfer

Phrases to use during the consultation

Information provision

Aimed at facilitating patients to ask for or decline participation in decision-making, accompany the central image.

GP-facilitator provides information regarding the elements of a shared decision-making approach to the consultation, in the context of older patients with multimorbidity.

Phrases are matched to the spectrum of patient preferences for involvement.

GP-facilitator delivers new messages about the potential benefits of shared decision-making. GP-facilitator uses a set of one or more meaningful premises and a conclusion to deliver these messages.

Messages

Inform the patient of their right to ask for involvement in decision-making about their care.

GP-facilitator provides positive messages regarding the role of the patient and their preferences within shared decision-making. (This information is designed using evidence from the literature regarding GPs current beliefs around shared decision-making with this patient group.)

Suggest that the patient possesses the capability to state their preferences for involvement to the GP.

GP facilitator provides information about the importance and relevance of a patient-centred approach to the consultation.

Emphasise the benefits of shared decision-making for the patient.

Messages delivered by GP-facilitator suggest that the GP possesses the capability to use a shared decision-making approach to the consultation.

GPs are asked to relay GP-facilitator’s messages to each other, and facilitator clarifies any confusion that appears during this process.

Role-play

GPs are first shown an example video-recorded consultation between the GP-facilitator (peer-model) and an actor-patient. GP-facilitator discusses the challenges of facilitating shared decision-making with the patient and how (s)he overcame them.

GPs take turns as the GP, the patient and the observer to role-play clinical scenarios in threes.

Individual GPs rehearse and repeat a shared decision-making approach to a role-play consultation, using a new ‘VOLITION’ model, incorporating a patient-centred, holistic approach.

The role-play ‘patient’ states their preference for involvement in decision-making about their healthcare; their ideas, concerns and expectations; and their preferred data format for decision-related information. In this way the ‘patient’ prompts the GP to use appropriate communication skills to match their shared decision-making preferences.

Clinical scenarios provide increasingly challenging tasks during role-play, with feedback from peers serving as an indicator of capability to the GP

GP-facilitator encourages elaboration to augment the information provided in the crib sheet for the case scenario.

Reflective discussion in threes followed by group feedback

Discussion of GP’s appropriate response to patient preferences, fundamental priorities and requirements

Discuss the experience and provide feedback to others.

GP-facilitator encourages elaboration to augment the information provided in the crib sheet for the case scenario.

Supporting reference materials

Handbook containing the VOLITION model and all of the key messages delivered by the GP-facilitator during the workshop, the case scenarios for role-play and space for the individual to write reflective notes. Also available online.

Online link to the video-recorded consultation between GP-facilitator and actor-patient.

Patient dialogue during index consultation

Patient provides a nudge to the GP in the form of a phrase from the patient support tool, informing the GP of their preferences for involvement in decision making about their care.

Acts as a cue to the GP to adapt their communication skills accordingly.