The 4-Circles Tool 2.0-A Tool to Prepare Older Patients for Shared Decision Making: A Developmental and Feasibility Study.

Background: Shared decision making is an effective strategy for collaborative goal setting and action planning with older patients. However, many older patients feel unable to actively participate. Increasing patient participation requires preparing patients for this process. The 4-Circles tool, a validated visual tool designed to support the goal setting phase of shared decision making, might serve as a preparation tool. This study describes the development of the 4-Circles tool 2.0 and examines its feasibility. Methods: We applied a human-centered design consisting of 3 phases: developing a prototype, exploring feasibility, and finalizing the 4-Circles tool 2.0. Data were collected through co-creation sessions with older patients ( Results: The 4-Circles tool 2.0 is a self-reflection booklet accompanied by training for professionals. The feasibility analysis showed that professionals gained deeper insights into older patients' personal goals. Older patients reported finding it easier to articulate their goals. However, professionals perceived that some older patients might lack the cognitive abilities required to complete the tool, adopted a passive role, or feared giving "wrong" answers. For some older patients, goal setting was not considered valuable because they perceived their potential for improvement as limited. Conclusion and Implications: Feasibility testing of the 4-Circles tool 2.0 showed that professionals gained deeper insights into older patients' goals. However, using self-reflection tools such as the 4-Circles tool 2.0 may be challenging because of the power asymmetry experienced between professionals and older patients. This issue should be addressed more actively during the implementation of such tools.