University of Exeter Collaboration for Academic Primary Care (APEx), University of Exeter Medical School, Exeter, UK.
NIHR School for Primary Care Research, Manchester Academic Health Science Centre, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK.
Patient Educ Couns. 2020 Oct;103(10):2078-2094. doi: 10.1016/j.pec.2020.04.008. Epub 2020 Apr 17.
To assess the effects of interventions aimed at involving older people with multimorbidity in decision-making about their healthcare during primary care consultations.
Cochrane methodological procedures were applied. Searches covered all relevant trial registries and databases. Randomised controlled trials were identified where interventions had been compared with usual care/ control/ another intervention. A narrative synthesis is presented; meta-analysis was not appropriate.
8160 abstracts and 54 full-text articles were screened. Three studies were included, involving 1879 patient participants. Interventions utilised behaviour change theory; cognitive-behavioural therapy and motivational interviewing; multidisciplinary, holistic patient review and organisational changes. No studies reported the primary outcome 'patient involvement in decision-making about their healthcare'. Patient involvement was evident in the theory underpinning interventions. Certainty of evidence (assessed using GRADE) was limited by small studies and inconsistency in secondary outcomes measured.
The evidence base is currently too limited to interpret with certainty. Transparency in design and consistency in evaluation, using validated measures, is required for future interventions involving older patients with multimorbidity in decisions about their healthcare.
There is a large gap between clinical guidelines for multimorbidity and an evidence base for implementation of their recommendations during primary care consultations with older people.
评估旨在让患有多种疾病的老年人参与初级保健咨询中医疗保健决策的干预措施的效果。
应用 Cochrane 方法学程序。检索涵盖了所有相关的试验注册库和数据库。将干预措施与常规护理/对照/另一种干预措施进行比较的随机对照试验被确定。呈现了叙述性综述；不适合进行荟萃分析。
筛选了 8160 篇摘要和 54 篇全文文章。纳入了三项研究，涉及 1879 名患者参与者。干预措施利用了行为改变理论；认知行为疗法和动机访谈；多学科、全面的患者审查和组织变革。没有研究报告“患者参与关于其医疗保健的决策”这一主要结果。干预措施的理论基础中存在患者参与。由于小样本研究和测量的次要结果不一致，证据的确定性（使用 GRADE 评估）受到限制。
目前证据基础还不够确定。对于涉及患有多种疾病的老年患者的医疗保健决策的未来干预措施，需要在设计上具有透明度，并使用经过验证的措施进行一致性评估。
在为患有多种疾病的老年人进行初级保健咨询时，临床指南与实施其建议的证据基础之间存在很大差距。
