Collaborative goal setting with elderly patients with chronic disease or multimorbidity: a systematic review

BMC Geriatrics

Research Article

Marcel G. M. Olde Rikkert¹  Mirjam Harmsen²  Marjan J. Faber²  Gert P. Westert²  Neeltje P. C. A. Vermunt³ 

[1] Department of Geriatrics, Radboud university medical center/Radboud Alzheimer Center, PO Box 9101, NL-6500 HB, Nijmegen, Netherlands;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;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;

关键词: Health priority setting;    Goal setting;    Decision-making;    Chronic health condition;    Systematic review;    Multifactorial intervention;    Multimorbidity;    Elderly;   

DOI  :  10.1186/s12877-017-0534-0

 received in 2017-01-15, accepted in 2017-07-04,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundIt 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.MethodsThis 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.ResultsA 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.ConclusionsCollaborative 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.

【 授权许可】

CC BY   
© The Author(s). 2017