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107 Improving shared decision making for underserved groups: a qualitative study to inform interventions for surgery
  1. Christin Hoffmann1,
  2. Zille Huma2,
  3. Jennifer Hall2,
  4. Leila Rooshenas1,
  5. Kerry Avery1,
  6. Christie Cabral3,
  7. Hilary Bekker4,5,
  8. Val Snelgrove6,
  9. Jane M Blazeby1,7,
  10. Angus GK Mcnair1,8,
  11. on behalf of the ALPACA Study team
  1. 1National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
  2. 2Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
  3. 3Centre for Academic Primary Care, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
  4. 4Leeds Unit of Complex Intervention Development (LUCID), Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
  5. 5The Research Centre for Patient Involvement (ResCenPI), Department of Public Health, Aarhus University, Central Denmark Region, Denmark
  6. 6Patient representative, Bristol, UK
  7. 7Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
  8. 8North Bristol NHS Trust, Bristol, UK


Introduction Improving shared decision making(SDM) for surgery is important for 310million patients worldwide undergoing treatment annually.1 SDM interventions are often information-rich and sophisticated,2 benefitting educated, health literate and socioeconomically advantaged people.3 The ALPACA study aims to co-develop an inclusive decision support intervention that uses digital real-time monitoring and feedback of patients’ experience of SDM to achieve improvements in SDM before surgery. This study aims to better understand how the intervention can be optimised for under-served groups who are disproportionately affected by poor SDM.

Methods A qualitative study design employed face-to-face/remote data collection in two UK regions, selected to reach socio-economically diverse populations. Semi-structured interviews and focus groups were conducted with adult public members (starting October 2023). Recruitment purposively sampled individuals from under-served groups: economically disadvantaged, minority ethnic groups, older age. Transcripts were thematically analysed using inductive coding approaches.

Results Preliminary results from seven interviews revealed themes relevant to design of intervention components and potential impact of the intervention. Specifically, results suggest adaptations to real- time monitoring should include different language and non-digital (telephone, paper) options. Importance of the intervention’s mechanisms of change (building trust through community involvement) and assumptions (preference for anonymised feedback) were elicited. Detailed results will be shared in July 2024.

Discussion We have provided evidence of how to design interventions to improve SDM that maximises inclusivity. Results will inform programme theory development to articulate how, why, for whom and in what context intervention components work.

Conclusion(s) A qualitative investigation explored views of under-served groups on the design and impact of SDM interventions that use real-time monitoring and feedback of patients’ experience of SDM. Findings will inform future co-development of a decision support intervention to improve SDM before surgery.


  1. TG, Haynes AB, Molina G, Lipsitz SR, Esquivel MM, Uribe-Leitz T, et al. Estimate of the global volume of surgery in 2012: an assessment supporting improved health outcomes. Lancet. 2015;385:S11.

  2. Durand MA, Carpenter L, Dolan H, Bravo P, Mann M, Bunn F, et al. Do interventions designed to support shared decision- making reduce health inequalities? A systematic review and meta-analysis. PLoS One. 2014;9.

  3. Thomson R, Murtagh M, Khaw FM. Tensions in public health policy: patient engagement, evidence-based public health and health inequalities. Qual Saf Health Care. 2005;14:398–400.

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