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21. Jahrestagung des Deutschen Netzwerks Evidenzbasierte Medizin e. V.

Deutsches Netzwerk Evidenzbasierte Medizin e. V.

13. - 15.02.2020, Basel, Schweiz

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

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  • Ana Isabel Gonzalez - Johann Wolfgang Goethe University, Institute of General Practice, Deutschland
  • Christine Schmucker - Faculty of Medicine, University of Freiburg, Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center-University of Freiburg, Freiburg, Deutschland
  • Julia Nothacker - Faculty of Medicine, University of Freiburg, Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center-University of Freiburg, Freiburg, Deutschland
  • Edith Motschall - Faculty of Medicine, University of Freiburg, Institute of Medical Biometry and Statistics, Freiburg, Deutschland
  • Truc Sophia Nguyen - Johann Wolfgang Goethe University, Institute of General Practice, Deutschland
  • Maria-Sophie Brueckle - Johann Wolfgang Goethe University, Institute of General Practice, Deutschland
  • Jeanet Wilhelmina Blom - Leiden University Medical Center, Department of Public Health and Primary Care, Leiden, Niederlande
  • Kristian Röttger - Federal Joint Committee “Gemeinsamer Bundesausschuss”, Deutschland
  • Odette Wegwarth - Max Planck-Institute for Human Development, Center for Adaptive Rationality, Deutschland
  • Tammy Hoffmann - Faculty of Health Sciences and Medicine, Bond University, Faculty of Health Sciences and Medicine, Bond University, Australien
  • Sharon Strauss - University of Toronto, Department of Medicine, Toronto, Kanada
  • Ferdinand Gerlach - Johann Wolfgang Goethe University, Institute of General Practice, Deutschland
  • Joerg Meerpohl - Faculty of Medicine, University of Freiburg, Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center-University of Freiburg, Freiburg, Deutschland
  • Marjan van den Akker - Johann Wolfgang Goethe University, Institute of General Practice, Deutschland; Maastricht University, Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht, Niederlande
  • Christiane Muth - Johann Wolfgang Goethe University, Institute of General Practice, Deutschland

Nützliche patientenrelevante Forschung. 21. Jahrestagung des Deutschen Netzwerks Evidenzbasierte Medizin. Basel, Schweiz, 13.-15.02.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. Doc20ebmS4-V2-01

doi: 10.3205/20ebm023, urn:nbn:de:0183-20ebm0238

Published: February 12, 2020

© 2020 Gonzalez et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Background/research question: Although patient-centeredness has been embraced as a key principle in primary care consultations (‘Ariadne principles’), in clinical practice, it remains unclear how to elicit health-related preferences in older patients with multimorbidity, and how to help them construct preferences when they are not immediately apparent. The aim of this study is to map the existing evidence on health-related preferences of older patients with multimorbidity [1].

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 a 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). Except for one interventional, 151 studies were observational: 63 (41%) were qualitative (59 cross-sectional, 4 longitudinal), 85 (57%) quantitative (63 cross-sectional, 22 longitudinal), and three (2%) used mixed methods. The setting was specialized/mixed care in 85 (56%) and primary care in 54 (36%) 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 service (n=12, 8%) and screening/diagnostic testing (n= 1, 1%).

Conclusion: This evidence map presents the first systematic overview of studies addressing a variety of health-related preferences in older patients with multimorbidity. We identified clusters of studies addressing a broad range of relevant topics (e.g. end-of-life care preferences) across all settings and used mostly cross-sectional and observational qualitative and quantitative methods. We identified gaps in general, such as the scarcity of longitudinal studies to investigate changes of preferences over time, and interventional studies; more specifically we found just one study addressing preference-sensitive decisions on screening and diagnostic testing. The terminology and concepts used to address health-related preferences varied considerably in the included studies, highlighting a need for more standardisation to improve further research.

Competing interests: This work was supported by the German Federal Ministry of Education and Research, grant number 01GL1729. The funder had no role in developing the protocol or results for this review.

Authors do not have any conflict of interest to declare.

Outline

References

1.
González-González AI, Schmucker C, Blom J, van den Akker M, Nguyen TS, Nothacker J, et al. Health-related preferences of older patients with multimorbidity: the protocol for an evidence map. BMJ Open. 2019 Sep 3;9(9):e029724.