Interventions for involving older patients with multimorbidity in decision‐making during primary care consultations

Abstract

Background The number of older people with more than one long-term health problem is steadily increasing worldwide. Such individuals can have complicated healthcare needs. Although they frequently want to be involved in making decisions about their health care, they are less often involved than younger, healthier people. As a result, they may not be offered the same treatment options. Review question We reviewed available evidence about the effects of interventions intended to involve older people with more than one long-term health problem in decision-making about their health care during primary care consultations. Study characteristics We included research published up until August 2018. We found three relevant studies involving 1879 participants. These studies were reported from three countries. Participants were over 65 years of age with three or more long-term health problems on average. Interventions investigated included: · patient workshops and individual patient coaching; · patient coaching including cognitive-behavioural therapy; and Selection criteria We sought randomised controlled trials (RCTs), cluster-RCTs, and quasi-RCTs of interventions to involve patients in decision-making about their health care versus usual care/control/another intervention, for patients aged 65 years and older with multi-morbidity in primary care. Data collection and analysis We used standard Cochrane methodological procedures. Meta-analysis was not possible; therefore we prepared a narrative synthesis. Main results We included three studies involving 1879 participants: two RCTs and one cluster-RCT. Interventions consisted of: · patient workshop and individual coaching using behaviour change techniques; · whole-person patient review, practitioner training, and organisational changes. All studies were funded by national research bodies. Key results None of the studies reported the main outcome ‘patient involvement in decision-making about their health care’ nor whether there was less patientinvolvement as a result ofthe intervention. Interventions were notfound to increase adverse outcomes such as death, anxiety, emergency department attendance, or hospital admissions.. We are uncertain whetherinterventions forinvolving older people with more than one long-term health problem in decision-making about their health care can improve their self-rated health or healthcare engagement, or make any difference in self-efficacy (one's belief in one's ability to succeed in specific situations) or in the overall number of general practice visits. We can report that these interventions probably make little or no difference in patients' quality of life but probably increase the number of patients discussing their priorities, and are associated with more patient consultations with nurses, when compared to usual care. Interventions may be associated with more changes in the management of health conditions when considered from the patient’s perspective when compared with a control group. The quality of the evidence was limited by small studies, and by studies choosing to measure different outcomes, resulting in lack of data that could be combined in analyses. Conclusions Further research in this developing area is required before firm conclusions can be drawn