Health-related preferences of older patients with multimorbidity: an evidence map

Abstract

ObjectivesTo systematically identify knowledge clusters and research gaps in the health-related preferences of older patients with multimorbidity by mapping current evidence.DesignEvidence map (systematic review variant).Data sourcesMEDLINE, EMBASE, PsycINFO, PSYNDEX, CINAHL and Science Citation Index/Social Science Citation Index/-Expanded from inception to April 2018.Study selectionStudies reporting primary research on health-related preferences of older patients (mean age ≥60 years) with multimorbidity (≥2 chronic/acute conditions).Data extractionTwo independent reviewers assessed studies for eligibility, extracted data and clustered the studies using MAXQDA-18 content analysis software.ResultsThe 152 included studies (62% from North America, 28% from Europe) comprised 57 093 patients overall (range 9–9105). All used an observational design except for one interventional study: 63 (41%) were qualitative (59 cross-sectional, 4 longitudinal), 85 (57%) quantitative (63 cross-sectional, 22 longitudinal) and 3 (2%) used mixed methods. The setting was specialised care in 85 (56%) and primary care in 54 (36%) studies. We identified seven clusters of studies on preferences: end-of-life care (n=51, 34%), self-management (n=34, 22%), treatment (n=32, 21%), involvement in shared decision making (n=25, 17%), health outcome prioritisation/goal setting (n=19, 13%), healthcare service (n=12, 8%) and screening/diagnostic testing (n=1, 1%). Terminology (eg, preferences, views and perspectives) and concepts (eg, trade-offs, decision regret, goal setting) used to describe health-related preferences varied substantially between studies.ConclusionOur study provides the first evidence map on the preferences of older patients with multimorbidity. Included studies were mostly conducted in developed countries and covered a broad range of issues. Evidence on patient preferences concerning decision-making on screening and diagnostic testing was scarce. Differences in employed terminology, decision-making components and concepts, as well as the sparsity of intervention studies, are challenges for future research into evidence-based decision support seeking to elicit the preferences of older patients with multimorbidity and help them construct preferences.Trial registration numberOpen Science Framework (OSF): DOI 10.17605/OSF.IO/MCRWQ.

End-of-Life Care Preferences of Older Patients with Multimorbidity: A Mixed Methods Systematic Review

“…To provide decision support to health professionals and help this complex patient population in an emotionally difficult situation, we systematically reviewed EoL care preferences in older patients with multimorbidity. We based the review on a knowledge cluster of EoL care preferences that we previously identified for an evidence map we developed on health-related preferences in older patients with multimorbidity [ 8 ].…”

Effectiveness of an eHealth self-management tool for older adults with multimorbidity (KeepWell): protocol for a hybrid effectiveness–implementation randomised controlled trial

“… 8 A recent review found that top health-related patient preferences of older patients with multimorbidity are health outcome prioritisation and goal setting and self-management. 9 In recent years, self-management tools have been acknowledged as an effective way to optimise disease management because persons can ‘function on their own behalf in health promotion, disease prevention and management’. 10 11 Self-management tools also have the potential to alleviate time and resource burdens on primary care healthcare professionals (eg, physicians, nurses, dietitians and pharmacists) who most often are left to address all aspects of disease management (ie, risk assessment, diagnosis and treatment).…”

Training General Practitioners and Medical Assistants Within the Framework of HoPES3, a Holistic Care Program for Elderly Patients to Integrate Spiritual Needs, Social Activity, and Self-Care into Disease Management in Primary Care

“…1 We argue that a more holistic approach for the care of elderly, chronically ill patients is needed which considers three aspects strongly linked to self-efficacy: patients' spiritual needs, social activity and self-care, i.e., patients' activeness in areas that can enhance well-being other than taking medication. [2][3][4] Studies show that patients have voiced the wish for holistic attention from their physician, 5,6 while many GPs acknowledge that meeting these needs should be an integral part of primary care. 4,[7][8][9] At the same time, patients and GPs alike report a lack in competencies on the part of the physician in terms of providing holistic primary care, in particular in meeting patients' spiritual needs.…”