Guideline-Based Decision-Making in Multimorbidity Care: A Semi-Structured Interview Study

The management of multimorbidity often requires applying multiple disease-specific guidelines, which may lead to harmful disease and drug interactions. The objective of the study was to collect the opinions of leading experts on factors influencing the use of guidelines in decision-making in multimorbidity management from a multidisciplinary perspective, and provide empirical insights to inform guideline-based decision support.

We conducted a series of semi-structured interviews with experts in multimorbidity research and practice and guideline development to participate. Interviewees were selected using purposive sampling. Our interviews covered the current use of clinical guidelines in multimorbidity management, key barriers and facilitators, and priority action areas. Thematic analysis was performed using NVivo 12.0.

Fifteen experts from nine countries were interviewed. The lack of multimorbidity-specific guidelines and recommendations may lead healthcare providers to either rely solely on personal experience, or follow guidelines without considering the needs and comorbidities of individual patients. Major barriers to guideline application include insufficient evidence and limited awareness and training among clinicians in both multimorbidity management and guideline implementation. The interviewees emphasized flexible use of guidelines, prioritizing patient values and preferences, and individualized management goals informed by (rather than strictly adhering to) guidelines.

Applying guidelines in multimorbidity care faces major evidence and applicability gaps. Particularly the generation of high-quality clinical evidence specific to multimorbidity, enhancing the methodological rigor in guideline development, and improvement of the contextual relevance and usability of guidelines in real-world settings need more attention.