End-of-Life Care Preferences of Older Patients with Multimorbidity: A Mixed Methods Systematic Review

Ana I González-González, Christine Schmucker, Julia Nothacker, Edris Nury, Truc Sophia Dinh, Maria-Sophie Brueckle, Jeanet W Blom, Marjan van den Akker, Kristian Röttger, Odette Wegwarth, Tammy Hoffmann, Ferdinand M Gerlach, Sharon E Straus, Joerg J Meerpohl, Christiane Muth

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Abstract

Unpredictable disease trajectories make early clarification of end-of-life (EoL) care preferences in older patients with multimorbidity advisable. This mixed methods systematic review synthesizes studies and assesses such preferences. Two independent reviewers screened title/abstracts/full texts in seven databases, extracted data and used the Mixed Methods Appraisal Tool to assess risk of bias (RoB). We synthesized findings from 22 studies (3243 patients) narratively and, where possible, quantitatively. Nineteen studies assessed willingness to receive life-sustaining treatments (LSTs), six, the preferred place of care, and eight, preferences regarding shared decision-making processes. When unspecified, 21% of patients in four studies preferred any LST option. In three studies, fewer patients chose LST when faced with death and deteriorating health, and more when treatment promised life extension. In 13 studies, 67% and 48% of patients respectively were willing to receive cardiopulmonary resuscitation and mechanical ventilation, but willingness decreased with deteriorating health. Further, 52% of patients from three studies wished to die at home. Seven studies showed that unless incapacitated, most patients prefer to decide on their EoL care themselves. High non-response rates meant RoB was high in most studies. Knowledge of EoL care preferences of older patients with multimorbidity increases the chance such care will be provided.

Original languageEnglish
Article number91
Number of pages24
JournalJournal of Clinical Medicine
Volume10
Issue number1
Early online date29 Dec 2020
DOIs
Publication statusPublished - Jan 2021

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