Health-related preferences of older patients with multimorbidity: an evidence map. Issue 12 (15th December 2019)

• Record Type: Journal Article
• Authors: Gonzalez, Ana Isabel; Schmucker, Christine; Nothacker, Julia; Motschall, Edith; Nguyen, Truc Sophia; Brueckle, Maria-Sophie; Blom, Jeanet; van den Akker, Marjan; Röttger, Kristian; Wegwarth, Odette; Hoffmann, Tammy; Straus, Sharon E; Gerlach, Ferdinand M; Meerpohl, Joerg J; Muth, Christiane
• Is Part Of: BMJ open. Volume 9:Issue 12(2019)
• Publication Date: 2019-12-15
• Subjects: general medicine (see internal medicine) -- internal medicine -- geriatric medicine; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2019-034485
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : Objectives: To systematically identify knowledge clusters and research gaps in the health-related preferences of older patients with multimorbidity by mapping current evidence. Design: Evidence map (systematic review variant). Data sources: MEDLINE, EMBASE, PsycINFO, PSYNDEX, CINAHL and Science Citation Index/Social Science Citation Index/-Expanded from inception to April 2018. Study selection: Studies reporting primary research on health-related preferences of older patients (mean age ≥60 years) with multimorbidity (≥2 chronic/acute conditions). Data extraction: Two independent reviewers assessed studies for eligibility, extracted data and clustered the studies using MAXQDA-18 content analysis software. Results: The 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. Conclusion: Our 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 number: Open Science Framework (OSF): DOI 10.17605/OSF.IO/MCRWQ.