Vermunt Neeltje P C A, Harmsen Mirjam, Westert Gert P, Olde Rikkert Marcel G M, Faber Marjan J
Radboud university medical center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), PO Box 9101, NL-6500 HB, Nijmegen, Netherlands.
The Dutch Council for Health and Society (Raad voor Volksgezondheid en Samenleving, RVS), PO Box 19404, NL-2500 CK, The Hague, Netherlands.
BMC Geriatr. 2017 Jul 31;17(1):167. doi: 10.1186/s12877-017-0534-0.
It is challenging to use shared decision-making with patients who have a chronic health condition or, especially, multimorbidity. A patient-goal-oriented approach can thus be beneficial. This study aims to identify and evaluate studies on the effects of interventions that support collaborative goal setting or health priority setting compared to usual care for elderly people with a chronic health condition or multimorbidity.
This systematic review was based on EPOC, PRISMA and MOOSE guidelines. Pubmed, PsychInfo, CINAHL, Web of Science, Embase and the Cochrane Central Register of Controlled Trials were searched systematically. The following eligibility criteria were applied: 1. Randomised (cluster) controlled trials, non-randomised controlled trials, controlled before-after studies, interrupted time series or repeated measures study design; 2. Single intervention directed specifically at collaborative goal setting or health priority setting or a multifactorial intervention including these elements; 3. Study population of patients with multimorbidity or at least one chronic disease (mean age ± standard deviation (SD) incl. age 65). 4. Studies reporting on outcome measures reducible to outcomes for collaborative goal setting or health priority setting.
A narrative analysis was performed. Eight articles describing five unique interventions, including four cluster randomised controlled trials and one randomised controlled trial, were identified. Four intervention studies, representing 904, 183, 387 and 1921 patients respectively, were multifactorial and showed statistically significant effects on the application of goal setting (Patient Assessment of Chronic Illness Care (PACIC) goal setting subscale), the number of advance directives or the inclusion of goals in care plans. Explicit attention for goal setting or priority setting by a professional was a common element in these multifactorial interventions. One study, which implemented a single-factor intervention on 322 patients, did not have significant effects on doctor-patient agreement. All the studies had methodological concerns in varying degrees.
Collaborative goal setting and/or priority setting can probably best be integrated in complex care interventions. Further research should determine the mix of essential elements in a multifactorial intervention to provide recommendations for daily practice. In addition, the necessity of methodological innovation and the application of mixed evaluation models must be highlighted to deal with the complexity of goal setting and/or priority setting intervention studies.
对于患有慢性健康状况尤其是患有多种疾病的患者，采用共同决策具有挑战性。因此，以患者目标为导向的方法可能会有所帮助。本研究旨在识别和评估与针对患有慢性健康状况或多种疾病的老年人的常规护理相比，支持协作式目标设定或健康优先事项设定的干预措施效果的研究。
本系统评价基于EPOC、PRISMA和MOOSE指南。系统检索了PubMed、PsychInfo、CINAHL、Web of Science、Embase和Cochrane对照试验中央注册库。应用了以下纳入标准：1. 随机（整群）对照试验、非随机对照试验、前后对照研究、中断时间序列或重复测量研究设计；2. 专门针对协作式目标设定或健康优先事项设定的单一干预措施，或包含这些要素的多因素干预措施；3. 患有多种疾病或至少一种慢性病的患者研究人群（平均年龄±标准差（SD），包括65岁及以上）。4. 报告的结局指标可归纳为协作式目标设定或健康优先事项设定的结局指标。
进行了叙述性分析。共识别出8篇描述5种独特干预措施的文章，包括4项整群随机对照试验和1项随机对照试验。4项干预研究分别涉及904、183、387和1921名患者，属于多因素干预措施，并且对目标设定的应用（慢性病护理患者评估（PACIC）目标设定子量表）、预立医嘱数量或护理计划中目标的纳入显示出统计学上的显著效果。专业人员对目标设定或优先事项设定的明确关注是这些多因素干预措施中的一个共同要素。一项对322名患者实施单因素干预的研究，对医患一致性没有显著影响。所有研究都存在不同程度的方法学问题。
协作式目标设定和/或优先事项设定可能最好整合到复杂的护理干预措施中。进一步的研究应确定多因素干预措施中基本要素的组合，以便为日常实践提供建议。此外，必须强调方法学创新的必要性以及混合评估模型的应用，以应对目标设定和/或优先事项设定干预研究的复杂性。
