Involving older people with multimorbidity in decision-making about their primary healthcare: A Cochrane systematic review of interventions (abridged)

Butterworth, Joanne; Hays, Rebecca; McDonagh, Sinéad T J; Bower, Peter; Pitchforth, Emma; Richards, Suzanne H; Campbell, John L.

doi:10.1016/j.pec.2020.04.008

Cited by 8 publications

(18 citation statements)

References 46 publications

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“…About one third preferred to decide as much as possible themselves and two thirds preferred to take decisions together with their GP or other specialists, reflecting great support for shared decision making. These findings support the results of previous studies that also older people value an active role in decision making about their health and care 41 …”

Section: Discussionsupporting

confidence: 92%

“…These findings support the results of previous studies that also older people value an active role in decision making about their health and care. 41 …”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have shown care coordination to be a core element of high‐quality multimorbidity care, 8 , 41 , 42 , 43 also highly valued by (older) people with multimorbidity themselves. 20 , 21 This was confirmed by our qualitative study revealing that all participants felt care coordination a key element of multimorbidity care.…”

Section: Discussionmentioning

confidence: 99%

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Priorities and preferences for care of people with multiple chronic conditions

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Stüssgen

Leemrijse

et al. 2021

Health Expectations

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Background To guide the development of high‐quality care for people with multiple chronic conditions, partners of the European Joint Action CHRODIS developed the Integrated Multimorbidity Care Model. To assess its suitability for improving care for people with multimorbidity in the Netherlands, the model was piloted in a primary care setting with both patients and care providers. Aim This paper reports on the patient perspective, and aims to explore the priorities, underlying values and preferences for care of people with multimorbidity. Participants and methods Twenty persons with multimorbidity (selected from general practice registries) participated in a focus group or telephone interview. Subsequently, a questionnaire was completed by 863 persons with multimorbidity registered with 14 general practices. Qualitative data were thematically analysed and quantitative data by means of descriptive statistics. Results Frequently prioritized elements of care were the use of shared electronic health records, regular comprehensive assessments, self‐management support and shared decision making, and care coordination. Preferences for how these elements should be specifically addressed differed according to individual values (eg weighing safety against privacy) and needs (eg ways of coping with multimorbidity). Conclusion The JA‐CHRODIS Integrated Multimorbidity Care Model reflects the priorities and preferences for care of people with multimorbidity in the Netherlands, which supports its relevance to guide the development of person‐centred integrated care for people with multiple chronic conditions in the Netherlands. Patient contribution European patient experts contributed to the development and applicability assessment of the JA‐CHRODIS Integrated Multimorbidity Care Model; Dutch patients participated in focus groups, interviews and a survey.

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Section: Discussionsupporting

confidence: 92%

“…These findings support the results of previous studies that also older people value an active role in decision making about their health and care. 41 …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Priorities and preferences for care of people with multiple chronic conditions

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Stüssgen

Leemrijse

et al. 2021

Health Expectations

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“…Miller et al 34 identified the most common elements of self‐management interventions for persons with MCCs in 31 studies, finding that education was most common (present in 31/31 included studies), followed by action planning/goal setting, self‐monitoring, and social/peer support (in 6 of 31) studies. Just one of the reviews on interventions (by Butterworth et al 30 ) used a standardized checklist (the Template for Intervention Description and Replication [TIDieR] checklist) 36 to organize findings.…”

Section: Principal Findingsmentioning

confidence: 99%

“…Of the six included reviews, just one explicitly described itself as a review of “engagement” using the term explicitly; this review focused on interventions (Table 4). 33 Another review focused on interventions involving individuals with MCCs in decision making, 30 and four reviews focused on self‐management among those with MCC. Of the four reviews of self‐management, two described characteristics and challenges of self‐management, 31,35 one described the assessment of self‐management, 35 and one focused on self‐management interventions 34 .…”

Section: Principal Findingsmentioning

confidence: 99%

A scoping review of person and family engagement in the context of multiple chronic conditions

Vick

Wolff

2021

Health Services Research

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Objective To review definitions, concepts, and evidence regarding person and family engagement for persons with multiple chronic conditions (MCCs) in order to identify opportunities to advance the field. Data Source Ovid MEDLINE. Study Design We performed a two‐step process as follows: (1) a critical review of conceptual models of engagement to identify key concepts most pertinent to engagement among persons with MCC as a “launch pad” to our scoping review and (2) a scoping review of reviews of engagement for persons living with MCC. Data Collection/Extraction Methods First, we critically reviewed six models of engagement. Second, our scoping review identified 1297 citations, with 67 articles meeting criteria for inclusion. Of these, we focused on reviews, of which there were nine titles/abstracts retained for full‐text consideration. Six full‐text reviews were included in the final analysis. The purpose, review type, population, number/type of included studies, theoretical framework, and findings of each study were extracted and analyzed thematically. Principal Findings Conceptual models of engagement differ with respect to areas of emphasis (e.g., systems or clinical encounters) as well as attention to vulnerable populations, involvement of family, consideration of cost–benefit trade‐offs, and attention to outcomes that matter most. Our scoping review of reviews identified just one article explicitly focused on engagement interventions for those with MCC. Other reviews examined elements of self‐management and involvement in decision making, conceptually related to engagement without explicit use of the word. We find that existing evidence has predominantly described individual‐level strategies rather than targeting organizations, systems, or policies. Barriers to engagement are not well described nor are potential downsides to engagement. Family engagement is rarely considered. Conclusions Promising areas of future work include attention to barriers to engagement including trust, goal‐based care, the design of structural changes to care delivery, trade‐offs between benefits and costs, and family engagement.

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Patient Priorities–Aligned Care for Older Adults With Multiple Conditions

Tinetti,

Hashmi,

et al. 2024

JAMA Netw Open

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ImportanceOlder adults with multiple conditions receive health care that may be burdensome, of uncertain benefit, and not focused on what matters to them. Identifying and aligning care with patients’ health priorities may improve outcomes.ObjectiveTo assess the association of receiving patient priorities care (PPC) vs usual care (UC) with relevant clinical outcomes.Design, Setting, and ParticipantsIn this nonrandomized controlled trial with propensity adjustment, enrollment occurred between August 21, 2020, and May 14, 2021, with follow-up continuing through February 26, 2022. Patients who were aged 65 years or older and with 3 or more chronic conditions were enrolled at 1 PPC and 1 UC site within the Cleveland Clinic primary care multisite practice. Data analysis was performed from March 2022 to August 2023.InterventionHealth professionals at the PPC site guided patients through identification of values, health outcome goals, health care preferences, and top priority (ie, health problem they most wanted to focus on because it impeded their health outcome goal). Primary clinicians followed PPC decisional strategies (eg, use patients’ health priorities as focus of communication and decision-making) to decide with patients what care to stop, start, or continue.Main Outcomes and MeasuresMain outcomes included perceived treatment burden, Patient-Reported Outcomes Measurement Information System (PROMIS) social roles and activities, CollaboRATE survey scores, the number of nonhealthy days (based on healthy days at home), and shared prescribing decision quality measures. Follow-up was at 9 months for patient-reported outcomes and 365 days for nonhealthy days.ResultsA total of 264 individuals participated, 129 in the PPC group (mean [SD] age, 75.3 [6.1] years; 66 women [48.9%]) and 135 in the UC group (mean [SD] age, 75.6 [6.5] years; 55 women [42.6%]). Characteristics between sites were balanced after propensity score weighting. At follow-up, there was no statistically significant difference in perceived treatment burden score between groups in multivariate models (difference, −5.2 points; 95% CI, −10.9 to −0.50 points; P = .07). PPC participants were almost 2.5 times more likely than UC participants to endorse shared prescribing decision-making (adjusted odds ratio, 2.40; 95% CI, 0.90 to 6.40; P = .07), and participants in the PPC group experienced 4.6 fewer nonhealthy days (95% CI, −12.9 to −3.6 days; P = .27) compared with the UC participants. These differences were not statistically significant. CollaboRATE and PROMIS Social Roles and Activities scores were similar in the 2 groups at follow-up.Conclusions and RelevanceThis nonrandomized trial of priorities-aligned care showed no benefit for social roles or CollaboRATE. While the findings for perceived treatment burden and shared prescribing decision-making were not statistically significant, point estimates for the findings suggested that PPC may hold promise for improving these outcomes. Randomized trials with larger samples are needed to determine the effectiveness of priorities-aligned care.Trial RegistrationClinicalTrials.gov Identifier: NCT04510948

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Involving older people with multimorbidity in decision-making about their primary healthcare: A Cochrane systematic review of interventions (abridged)

Cited by 8 publications

References 46 publications

Priorities and preferences for care of people with multiple chronic conditions

Priorities and preferences for care of people with multiple chronic conditions

A scoping review of person and family engagement in the context of multiple chronic conditions

Patient Priorities–Aligned Care for Older Adults With Multiple Conditions

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