Health-related preferences of older patients with multimorbidity

An evidence map

Ana Isabel Gonzalez, Christine Schmucker*, Julia Nothacker, Edith Motschall, Truc Sophia Nguyen, Maria Sophie Brueckle, Jeanet Blom, Marjan Van Den Akker, Kristian Röttger, Odette Wegwarth, Tammy Hoffmann, Sharon E. Straus, Ferdinand M. Gerlach, Joerg J. Meerpohl, Christiane Muth

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

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Abstract

Objectives To systematically identify knowledge clusters and research gaps in the health-related preferences of older patients with multimorbidity by mapping current evidence. Design Evidence map (systematic review variant). Data sources MEDLINE, EMBASE, PsycINFO, PSYNDEX, CINAHL and Science Citation Index/Social Science Citation Index/-Expanded from inception to April 2018. Study selection Studies reporting primary research on health-related preferences of older patients (mean age ≥60 years) with multimorbidity (≥2 chronic/acute conditions). Data extraction Two independent reviewers assessed studies for eligibility, extracted data and clustered the studies using MAXQDA-18 content analysis software. Results The 152 included studies (62% from North America, 28% from Europe) comprised 57 093 patients overall (range 9-9105). All used an observational design except for one interventional study: 63 (41%) were qualitative (59 cross-sectional, 4 longitudinal), 85 (57%) quantitative (63 cross-sectional, 22 longitudinal) and 3 (2%) used mixed methods. The setting was specialised care in 85 (56%) and primary care in 54 (36%) studies. We identified seven clusters of studies on preferences: end-of-life care (n=51, 34%), self-management (n=34, 22%), treatment (n=32, 21%), involvement in shared decision making (n=25, 17%), health outcome prioritisation/goal setting (n=19, 13%), healthcare service (n=12, 8%) and screening/diagnostic testing (n=1, 1%). Terminology (eg, preferences, views and perspectives) and concepts (eg, trade-offs, decision regret, goal setting) used to describe health-related preferences varied substantially between studies. Conclusion Our study provides the first evidence map on the preferences of older patients with multimorbidity. Included studies were mostly conducted in developed countries and covered a broad range of issues. Evidence on patient preferences concerning decision-making on screening and diagnostic testing was scarce. Differences in employed terminology, decision-making components and concepts, as well as the sparsity of intervention studies, are challenges for future research into evidence-based decision support seeking to elicit the preferences of older patients with multimorbidity and help them construct preferences. Trial registration number Open Science Framework (OSF): DOI 10.17605/OSF.IO/MCRWQ.

Original languageEnglish
Article number034485
JournalBMJ Open
Volume9
Issue number12
DOIs
Publication statusPublished - 15 Dec 2019

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Patient Preference
Comorbidity
Health
Decision Making
Terminology
Terminal Care
Social Sciences
Information Storage and Retrieval
Self Care
North America
Research
Developed Countries
MEDLINE
Primary Health Care
Emotions
Software
Delivery of Health Care

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Gonzalez, A. I., Schmucker, C., Nothacker, J., Motschall, E., Nguyen, T. S., Brueckle, M. S., ... Muth, C. (2019). Health-related preferences of older patients with multimorbidity: An evidence map. BMJ Open, 9(12), [034485]. https://doi.org/10.1136/bmjopen-2019-034485
Gonzalez, Ana Isabel ; Schmucker, Christine ; Nothacker, Julia ; Motschall, Edith ; Nguyen, Truc Sophia ; Brueckle, Maria Sophie ; Blom, Jeanet ; Van Den Akker, Marjan ; Röttger, Kristian ; Wegwarth, Odette ; Hoffmann, Tammy ; Straus, Sharon E. ; Gerlach, Ferdinand M. ; Meerpohl, Joerg J. ; Muth, Christiane. / Health-related preferences of older patients with multimorbidity : An evidence map. In: BMJ Open. 2019 ; Vol. 9, No. 12.
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title = "Health-related preferences of older patients with multimorbidity: An evidence map",
abstract = "Objectives To systematically identify knowledge clusters and research gaps in the health-related preferences of older patients with multimorbidity by mapping current evidence. Design Evidence map (systematic review variant). Data sources MEDLINE, EMBASE, PsycINFO, PSYNDEX, CINAHL and Science Citation Index/Social Science Citation Index/-Expanded from inception to April 2018. Study selection Studies reporting primary research on health-related preferences of older patients (mean age ≥60 years) with multimorbidity (≥2 chronic/acute conditions). Data extraction Two independent reviewers assessed studies for eligibility, extracted data and clustered the studies using MAXQDA-18 content analysis software. Results The 152 included studies (62{\%} from North America, 28{\%} from Europe) comprised 57 093 patients overall (range 9-9105). All used an observational design except for one interventional study: 63 (41{\%}) were qualitative (59 cross-sectional, 4 longitudinal), 85 (57{\%}) quantitative (63 cross-sectional, 22 longitudinal) and 3 (2{\%}) used mixed methods. The setting was specialised care in 85 (56{\%}) and primary care in 54 (36{\%}) studies. We identified seven clusters of studies on preferences: end-of-life care (n=51, 34{\%}), self-management (n=34, 22{\%}), treatment (n=32, 21{\%}), involvement in shared decision making (n=25, 17{\%}), health outcome prioritisation/goal setting (n=19, 13{\%}), healthcare service (n=12, 8{\%}) and screening/diagnostic testing (n=1, 1{\%}). Terminology (eg, preferences, views and perspectives) and concepts (eg, trade-offs, decision regret, goal setting) used to describe health-related preferences varied substantially between studies. Conclusion Our study provides the first evidence map on the preferences of older patients with multimorbidity. Included studies were mostly conducted in developed countries and covered a broad range of issues. Evidence on patient preferences concerning decision-making on screening and diagnostic testing was scarce. Differences in employed terminology, decision-making components and concepts, as well as the sparsity of intervention studies, are challenges for future research into evidence-based decision support seeking to elicit the preferences of older patients with multimorbidity and help them construct preferences. Trial registration number Open Science Framework (OSF): DOI 10.17605/OSF.IO/MCRWQ.",
author = "Gonzalez, {Ana Isabel} and Christine Schmucker and Julia Nothacker and Edith Motschall and Nguyen, {Truc Sophia} and Brueckle, {Maria Sophie} and Jeanet Blom and {Van Den Akker}, Marjan and Kristian R{\"o}ttger and Odette Wegwarth and Tammy Hoffmann and Straus, {Sharon E.} and Gerlach, {Ferdinand M.} and Meerpohl, {Joerg J.} and Christiane Muth",
year = "2019",
month = "12",
day = "15",
doi = "10.1136/bmjopen-2019-034485",
language = "English",
volume = "9",
journal = "BMJ Open",
issn = "2044-6055",
publisher = "BMJ Publishing Group",
number = "12",

}

Gonzalez, AI, Schmucker, C, Nothacker, J, Motschall, E, Nguyen, TS, Brueckle, MS, Blom, J, Van Den Akker, M, Röttger, K, Wegwarth, O, Hoffmann, T, Straus, SE, Gerlach, FM, Meerpohl, JJ & Muth, C 2019, 'Health-related preferences of older patients with multimorbidity: An evidence map', BMJ Open, vol. 9, no. 12, 034485. https://doi.org/10.1136/bmjopen-2019-034485

Health-related preferences of older patients with multimorbidity : An evidence map. / Gonzalez, Ana Isabel; Schmucker, Christine; Nothacker, Julia; Motschall, Edith; Nguyen, Truc Sophia; Brueckle, Maria Sophie; Blom, Jeanet; Van Den Akker, Marjan; Röttger, Kristian; Wegwarth, Odette; Hoffmann, Tammy; Straus, Sharon E.; Gerlach, Ferdinand M.; Meerpohl, Joerg J.; Muth, Christiane.

In: BMJ Open, Vol. 9, No. 12, 034485, 15.12.2019.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Health-related preferences of older patients with multimorbidity

T2 - An evidence map

AU - Gonzalez, Ana Isabel

AU - Schmucker, Christine

AU - Nothacker, Julia

AU - Motschall, Edith

AU - Nguyen, Truc Sophia

AU - Brueckle, Maria Sophie

AU - Blom, Jeanet

AU - Van Den Akker, Marjan

AU - Röttger, Kristian

AU - Wegwarth, Odette

AU - Hoffmann, Tammy

AU - Straus, Sharon E.

AU - Gerlach, Ferdinand M.

AU - Meerpohl, Joerg J.

AU - Muth, Christiane

PY - 2019/12/15

Y1 - 2019/12/15

N2 - Objectives To systematically identify knowledge clusters and research gaps in the health-related preferences of older patients with multimorbidity by mapping current evidence. Design Evidence map (systematic review variant). Data sources MEDLINE, EMBASE, PsycINFO, PSYNDEX, CINAHL and Science Citation Index/Social Science Citation Index/-Expanded from inception to April 2018. Study selection Studies reporting primary research on health-related preferences of older patients (mean age ≥60 years) with multimorbidity (≥2 chronic/acute conditions). Data extraction Two independent reviewers assessed studies for eligibility, extracted data and clustered the studies using MAXQDA-18 content analysis software. Results The 152 included studies (62% from North America, 28% from Europe) comprised 57 093 patients overall (range 9-9105). All used an observational design except for one interventional study: 63 (41%) were qualitative (59 cross-sectional, 4 longitudinal), 85 (57%) quantitative (63 cross-sectional, 22 longitudinal) and 3 (2%) used mixed methods. The setting was specialised care in 85 (56%) and primary care in 54 (36%) studies. We identified seven clusters of studies on preferences: end-of-life care (n=51, 34%), self-management (n=34, 22%), treatment (n=32, 21%), involvement in shared decision making (n=25, 17%), health outcome prioritisation/goal setting (n=19, 13%), healthcare service (n=12, 8%) and screening/diagnostic testing (n=1, 1%). Terminology (eg, preferences, views and perspectives) and concepts (eg, trade-offs, decision regret, goal setting) used to describe health-related preferences varied substantially between studies. Conclusion Our study provides the first evidence map on the preferences of older patients with multimorbidity. Included studies were mostly conducted in developed countries and covered a broad range of issues. Evidence on patient preferences concerning decision-making on screening and diagnostic testing was scarce. Differences in employed terminology, decision-making components and concepts, as well as the sparsity of intervention studies, are challenges for future research into evidence-based decision support seeking to elicit the preferences of older patients with multimorbidity and help them construct preferences. Trial registration number Open Science Framework (OSF): DOI 10.17605/OSF.IO/MCRWQ.

AB - Objectives To systematically identify knowledge clusters and research gaps in the health-related preferences of older patients with multimorbidity by mapping current evidence. Design Evidence map (systematic review variant). Data sources MEDLINE, EMBASE, PsycINFO, PSYNDEX, CINAHL and Science Citation Index/Social Science Citation Index/-Expanded from inception to April 2018. Study selection Studies reporting primary research on health-related preferences of older patients (mean age ≥60 years) with multimorbidity (≥2 chronic/acute conditions). Data extraction Two independent reviewers assessed studies for eligibility, extracted data and clustered the studies using MAXQDA-18 content analysis software. Results The 152 included studies (62% from North America, 28% from Europe) comprised 57 093 patients overall (range 9-9105). All used an observational design except for one interventional study: 63 (41%) were qualitative (59 cross-sectional, 4 longitudinal), 85 (57%) quantitative (63 cross-sectional, 22 longitudinal) and 3 (2%) used mixed methods. The setting was specialised care in 85 (56%) and primary care in 54 (36%) studies. We identified seven clusters of studies on preferences: end-of-life care (n=51, 34%), self-management (n=34, 22%), treatment (n=32, 21%), involvement in shared decision making (n=25, 17%), health outcome prioritisation/goal setting (n=19, 13%), healthcare service (n=12, 8%) and screening/diagnostic testing (n=1, 1%). Terminology (eg, preferences, views and perspectives) and concepts (eg, trade-offs, decision regret, goal setting) used to describe health-related preferences varied substantially between studies. Conclusion Our study provides the first evidence map on the preferences of older patients with multimorbidity. Included studies were mostly conducted in developed countries and covered a broad range of issues. Evidence on patient preferences concerning decision-making on screening and diagnostic testing was scarce. Differences in employed terminology, decision-making components and concepts, as well as the sparsity of intervention studies, are challenges for future research into evidence-based decision support seeking to elicit the preferences of older patients with multimorbidity and help them construct preferences. Trial registration number Open Science Framework (OSF): DOI 10.17605/OSF.IO/MCRWQ.

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DO - 10.1136/bmjopen-2019-034485

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Gonzalez AI, Schmucker C, Nothacker J, Motschall E, Nguyen TS, Brueckle MS et al. Health-related preferences of older patients with multimorbidity: An evidence map. BMJ Open. 2019 Dec 15;9(12). 034485. https://doi.org/10.1136/bmjopen-2019-034485