Interventions for involving older patients with multimorbidity in decision-making during primary care consultations: A Cochrane systematic review.

Problem

Life expectancy is predicted to continue to rise globally and the prevalence of long-term conditions also increases with age. The consequences of ageing with multimorbidity include functional decline with poor quality of life, high healthcare utilisation and costs, and reduced life expectancy.Our previous work identified that older patients value being involved in decision-making about their healthcare. However, they are less frequently involved when compared with younger patients and there is evidence of associated health inequalities. These patients need support in prioritising and rationalising treatment options to maximise quality of life and day-to-day function.This review explores the effectiveness of interventions delivered with the aim of involving older patients with multimorbidity in decision-making about their healthcare during primary care consultations. It will inform the development of a new intervention to facilitate the involvement of this vulnerable patient group, in decision-making about their healthcare, during GP consultations.

Approach

A Cochrane systematic review of interventions.Study type: randomised controlled trials (RCTs), cluster-RCTs, and quasi-RCTs.Participant population: Patients aged 65 years and over with more than one long-term health problem.Interventions facilitating patient involvement in decision-making may refer to:- a practitioner, seeking to facilitate a patient's active engagement in decision-making - patients, increasing their own involvement in decision-making (including expressing a preference for involvement)- changes to the organisation of care; to more comprehensively address patients’ needs and preferences.Primary outcome: Evidence of patient involvement in decision-making during the consultation from patient and/or practitioner and/or observer perspectives.We searched the following electronic databases without language or date restriction: the Cochrane Central Register of Controlled Trials; MEDLINE; Embase; PsycINFO; CINAHL; DARE; HTA Database; Ongoing Reviews Database; and Dissertation Abstracts International.

Findings

Two review authors independently screened 8,252 abstracts; 49 full-text studies were assessed for eligibility; and data is currently being extracted for analysis from three included studies. Results will be available at the conference.

Consequences

There are concerns that current delivery of good quality care is not meeting the needs of older patients who often experience multimorbidity. These patients consult frequently and account for over a third of spending in primary care in the UK. The UK National Institute for Clinical Excellence published guidelines in 2016 for the clinical assessment and management of patients with multimorbidity, recommending more patient involvement in decision-making, and special consideration for vulnerable groups such as the elderly. However, to date there has been little instruction on how to facilitate patient involvement for this patient group. Our review aims to provide evidence-based guidance to policy makers, researchers, and commissioners about how to direct funding towards good quality interventions targeting the involvement of older patients in decision-making about their healthcare, and to provide practical guidance to clinicians when adopting these interventions.