Barriers and facilitators for shared decision making in older patients with multiple chronic conditions: a systematic review

Abstract

Background The aim of this study was to describe barriers and facilitators for shared decision making (SDM) as experienced by older patients with multiple chronic conditions (MCCs), informal caregivers and health professionals. Methods A structured literature search was conducted with 5 databases. Two reviewers independently assessed studies for eligibility and performed a quality assessment. The results from the included studies were summarized using a predefined taxonomy. Results Our search yielded 3838 articles. Twenty-eight studies, listing 149 perceived barriers and 67 perceived facilitators for SDM, were included. Due to poor health and cognitive and/or physical impairments, older patients with MCCs participate less in SDM. Poor interpersonal skills of health professionals are perceived as hampering SDM, as do organizational barriers, such as pressure for time and high turnover of patients. However, among older patients with MCCs, SDM could be facilitated when patients share information about personal values, priorities and preferences, as well as information about quality of life and functional status. Informal caregivers may facilitate SDM by assisting patients with decision support, although informal caregivers can also complicate the SDM process, for example, when they have different views on treatment or the patient’s capability to be involved. Coordination of care when multiple health professionals are involved is perceived as important. Conclusions Although poor health is perceived as a barrier to participate in SDM, the personal experience of living with MCCs is considered valuable input in SDM. An explicit invitation to participate in SDM is important to older adults. Health professionals need a supporting organizational context and good communication skills to devise an individualized approach for patient care.

Shared decision making between older people with multimorbidity and GPs: a qualitative study

“…Previous studies with GPs reported constraints on personalised care driven by an expectation to follow clinical guidelines (50)(51)(52)(53), with potentially inappropriate treatment and polypharmacy resulting (12,28,52,(54)(55)(56). Although differences in healthcare setting must be acknowledged when drawing comparisons with UK general practice, a focus group study in the United States of America explored a broader perspective by including other primary care clinicians as participants.…”

Factors affecting primary care physician decision-making for patients with complex multimorbidity: a qualitative interview study

“…Prior work describing this process more globally found that decisions are highly varied, with few generalizable conclusions for multimorbidity [ 21 , 32 ]. In one review, nearly two-thirds of the studies excluded patients with multimorbidity [ 32 ]; Other reviews have focused on specific facets of decision-making such as collaborative shared-decision making [ 33 , 34 ]. Heterogeneity in the decision-making literature may also due to an emphasis on care coordination in multimorbidity care, [ 35 , 36 ] which requires input from other care team members than physicians.…”

Relationships among inner strength, health and function, well-being, and negative life events in old people: a longitudinal study

“…It can be by paying attention and listening to their suggestions about their treatment and care. Many decisions are made without patient participation (Pel-Little et al 2021 ). Supporting patients’ flexibility can be about, in dialogue with the person concerned, finding ways for him/her to adapt life to new or changed conditions.…”