Article
Health-Related Preferences of Older Patients with Multimorbidity: an Evidence Map
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Authors
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Ana Isabel González-González
- Johann Wolfgang Goethe University, Institute of General Practice, Deutschland
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Christine Schmucker
- University of Freiburg, Institute for Evidence in Medicine (for Cochrane Germany Foundation) Medical Center, Freiburg, Deutschland
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Julia Nothacker
- University of Freiburg, Institute for Evidence in Medicine (for Cochrane Germany Foundation) Medical Center, Freiburg, Deutschland
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Truc Sophia Nguyen
- Johann Wolfgang Goethe University, Institute of General Practice, Deutschland
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Maria-Sophie Brueckle
- Johann Wolfgang Goethe University, Institute of General Practice, Deutschland
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Jeanet Blom
- Leiden University Medical Center, Department of Public Health and Primary Care, Leiden, Niederlande
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Marjan van den Akker
- Johann Wolfgang Goethe University, Institute of General Practice, Deutschland
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Joerg Meerpohl
- University of Freiburg, Institute for Evidence in Medicine (for Cochrane Germany Foundation) Medical Center, Freiburg, Deutschland
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Kristian Röttger
- Federal Joint Committee “Gemeinsamer Bundesausschuss”, Deutschland
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Odette Wegwarth
- Max Planck-Institute for Human Development, Center for Adaptive Rationality, Deutschland
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Tammy Hoffmann
- Bond University, Centre for Research in Evidence-Based Practice (CREBP), Faculty of Health Sciences and Medicine, Australien
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Sharon Straus
- University of Toronto, Department of Medicine, Kanada
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Ferdinand Gerlach
- Johann Wolfgang Goethe University, Institute of General Practice, Deutschland
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Christiane Muth
- Johann Wolfgang Goethe University, Institute of General Practice, Deutschland
| Published: | September 11, 2019 |
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Outline
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Background: In patients with multimorbidity, a patient-centered rather than disease-oriented approach is recommended. However, little is known about patients’ preferences and their inclusion in health-related decision-making.
Objective: To map the existing evidence on health-related preferences of older patients with multimorbidity.
Methods: We systematically searched for studies reporting preferences of older patients (mean age ≥60) with multimorbidity (≥2 chronic/acute conditions) in eight electronic databases (e.g., MEDLINE, EMBASE, PsycINFO…) up to April 2018. Two independent reviewers assessed studies for eligibility, extracted data and clustered the evidence by means of content analysis using MAXQDA-18.
Results: We included 152 studies (USA: n=84; UK: n=16; Canada: n=10; AUS/NZ: n=10; EU: n=27 – Germany: 6). One study was a cluster randomized trial, 151 studies were observational: 63 (41%) qualitative, 86 (57%) quantitative (66 cross-sectional, 19 longitudinal), and three (2%) used mixed-methods. The setting was specialized care in 85 (56%) and primary care in 53 (35%) studies. We identified seven evidence clusters consisting of studies on preferences in: 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 prioritization/goal setting (n=19, 13%), healthcare services (n=12, 8%) and screening/diagnostic testing (n= 1,1%). In primary care research, 21 (34%) studies focused on self-management, 12 (20%) on health outcome prioritization/goal setting and 7 (12%) end-of-life; no study addressed preferences in screening/diagnostic testing.
Discussion: This is the first evidence map on health-related preferences of older patients with multimorbidity, which mostly included observational studies on a variety of health-related preferences. We identified evidence gaps in screening/diagnostic testing and end-of-life preferences of these patients in primary care.
Take home message for practical use: A growing body of evidence on health-related preferences of older patients with multimorbidity can assist decision-making towards patient-centered care. Presented evidence clusters provide sources for systematic reviews and identified gaps may guide future research planning.
