Decision aids for the care of patients with multimorbidity: a systematic review

Patients with multimorbidity face complex decision-making needs, including decreasing polypharmacy burden, maintaining physical functioning and prolonging life. Patient decision aids (DAs) have been developed and implemented as clinical tools to support complex decision-making in the management of multimorbidity in primary care.

This study aimed to identify DAs developed for patients with multimorbidity, describe their characteristics, and assess their quality, feasibility, and effectiveness.

Citations from searches of nine databases were screened by title and abstract, and then full text articles were subsequently identified and screened. Any article utilising a DA for patients with multimorbidity was eligible. The International Patient Decision Aid Standards (IPDAS) checklist was used to assess the quality of DAs. The characteristics, quality, feasibility and effectiveness of DAs were summarized using descriptive methods.

In total, 10 articles including six DAs were included. The DAs were categorised as targeting either general multimorbidity or specific disease-combined multimorbidity. All included DAs need to be discussed and used together by general practitioners (GPs) and patients with multimorbidity. Four DAs focused on goal setting or preparing for physician-patient conversation in primary care settings. According to IPDAS evaluations, only one DA was rated as high-quality; the others were considered substandard, largely due to a lack of detail on decision trade-offs. Two DAs demonstrated good feasibility, but one showed feasibility only among clinicians and the other only among patients. For the effectiveness of DAs, two DAs was evaluated. One based on the quality of communication and collaboration in encounter and adherence to prescription medication, and the other the other based on the overall level of SDM or in patient-reported outcomes (such as decisional conflict). The evidence of effectiveness was very limited in the current studies.

This study identified six DAs for patients with multimorbidity, five of which lacked descriptions of the consequences of the options and their positive and negative features. The evidence for feasibility and effectiveness of current DAs is limited. High-quality experimental research should be conducted in the future to verify effectiveness.