Chronic kidney disease awareness, prevention and policy gaps with implications for the Nigerian Navy: a scoping review.

Current strategies to prepare older patients for shared decision making mainly focus on providing information and do not encourage them to reflect on their personal goals. Using a human-centered design, we further developed and tested a validated tool for shared decision making, the 4-Circles tool, and transformed it into a self-reflection booklet (4-Circles tool 2.0) that older patients can use independently to prepare for shared decisions about personal goals. Although feasibility testing of the 4-Circles tool 2.0 showed that professionals gained deeper insights into older patients’ personal goals, it also became clear that using self-reflection tools such as the 4-Circles tool 2.0 with older patients might be challenging due to an experienced power asymmetry between professionals and older patients. This issue needs to be addressed more actively during implementation.