Cochrane · systematic review · CD013124
Interventions for involving older patients with multi‐morbidity in decision‐making during primary care consultations
Butterworth, JE, Hays, R, McDonagh, STJ, et al. · Cochrane Database of Systematic Reviews · 2019 · Cochrane Library
Consumers and CommunicationAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
17
current version
GRADE rated
11
No studies
6
Included studies
NR
No studies 6 · 35.3%Ungraded 0 · 0%Very low 6 · 35.3%Low 1 · 5.9%Moderate 4 · 23.5%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Interventions for involving older patients with multi‐morbidity in decision‐making about their health care compared to usual care for older patients with multi‐morbidity
Population: older patients with multi‐morbidity
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Patient involvement in decision‐making (primary outcome) Not measured Interventions for involving older patients with multi‐morbidity in decision‐making about their health care vs usual care | no estimate extracted | NR | No studies |
Health status (a) Patient‐reported high self‐rated health at 6 months after baseline CDC Healthy Days Measure (CDC 2000): dichotomised as low (1 to 3) and high (4 to 5) Interventions for involving older patients with multi‐morbidity in decision‐making about their health care vs usual care | RR 1.4 [0.36, 5.49] | 1 study · 41 participants | Very low Downgraded: risk of bias |
Health status (b) Health‐related quality of life at 15 months after baseline EQ‐5D‐5L score (5 questions about mobility, self‐care, usual activities, pain and discomfort, anxiety and depression, each measured on a 5‐point scale from no problems to... Interventions for involving older patients with multi‐morbidity in decision‐making about their health care vs usual care | no estimate extracted | 1 study · 1546 participants | Moderate Downgraded: risk of bias, imprecision, indirectness |
Patient enablement and engagement (a) Patient Activation Measure score at 6 months after baseline (13‐item assessment of knowledge and confidence related to participation in care. Responses on a 4‐point scale are summed and converted to an ‘Activa... Interventions for involving older patients with multi‐morbidity in decision‐making about their health care vs usual care | no estimate extracted | 1 study · 41 participants | Very low Downgraded: risk of bias |
Patient enablement and engagement (b) Morisky Medication Adherence Scale at 15 months after baseline (8‐item yes‐no survey. Range of scores from 0 to 8. Lower scores suggest non‐adherence) (Morisky 2008) Interventions for involving older patients with multi‐morbidity in decision‐making about their health care vs usual care | no estimate extracted | 1 study · 1546 participants | Moderate Downgraded: risk of bias, imprecision, indirectness |
Patient evaluation of care/the intervention Care related to patient priorities at 15 months after baseline (single question adapted from the NHS General Practice Patient Survey (Ipsos MORI 2015); 5‐point scale dichotomised by patient reports of di... Interventions for involving older patients with multi‐morbidity in decision‐making about their health care vs usual care | OR 1.85 [1.44, 2.38] | 1 study · 1211 participants | Moderate Downgraded: risk of bias, imprecision, indirectness |
Practitioners' knowledge and skills Not measured Interventions for involving older patients with multi‐morbidity in decision‐making about their health care vs usual care | no estimate extracted | NR | No studies |
Resource use and cost Number of nurse consultations at 15 months after baseline (extracted from patients’ routine electronic medical records) Interventions for involving older patients with multi‐morbidity in decision‐making about their health care vs usual care | Rate ratio 1.37 [1.17, 1.61] | 1 study · 1517 participants | Moderate Downgraded: risk of bias, imprecision, indirectness |
Adverse events** Less patient involvement Not measured Interventions for involving older patients with multi‐morbidity in decision‐making about their health care vs usual care | no estimate extracted | NR | No studies |
Interventions for involving patients in decision‐making about their health care compared to attention‐control conditions for older patients with multi‐morbidity
Population: older patients with multi‐morbidity
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Patient involvement in decision‐making (primary outcome) Not measured Interventions for involving patients in decision‐making about their health care vs attention‐control conditions | no estimate extracted | NR | No studies |
Health status Patient‐reported high self‐rated health at 6 months after baseline. Hochhalter used CDC Healthy Days Measure (CDC 2000); Reed used a similar 5‐point Likert scale developed by the US National Health and Nutrition Examination Survey; e... Interventions for involving patients in decision‐making about their health care vs attention‐control conditions | no estimate extracted | 2 studies · 297 participants | Very low Downgraded: risk of bias |
Patient enablement and engagement (a) Patient activation at 6 months after baseline. Patient Activation Measure score (13‐item assessment of knowledge and confidence related to participation in care. Responses on a 4‐point scale are summed and con... Interventions for involving patients in decision‐making about their health care vs attention‐control conditions | no estimate extracted | 1 study · 43 participants | Very low Downgraded: risk of bias |
Patient enablement and engagement (b) Self‐efficacy at 6 months after baseline (self‐efficacy for managing chronic disease scale assessed from scores on 6 items rated 1 ‘not at all confident’ to 10 ‘totally confident’) (Stanford 2018) Higher score... Interventions for involving patients in decision‐making about their health care vs attention‐control conditions | no estimate extracted | 1 study · 254 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Patient evaluation of care/the intervention Patient reports that the intervention changed management of his or her health at 6 months after baseline (3‐point scale: dichotomised into 'a great deal' vs 'somewhat' + 'not at all') (Stanford 2018) Hig... Interventions for involving patients in decision‐making about their health care vs attention‐control conditions | RR 1.82 [1.35, 2.44] | 1 study · 231 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Practitioners' knowledge and skills Not measured Interventions for involving patients in decision‐making about their health care vs attention‐control conditions | no estimate extracted | NR | No studies |
Resource use and cost Number of general practice visits in the 6 months following baseline (patient self‐report via questionnaire) Interventions for involving patients in decision‐making about their health care vs attention‐control conditions | no estimate extracted | 1 study · 254 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Adverse event** Less patient involvement as a result of the intervention Not measured Interventions for involving patients in decision‐making about their health care vs attention‐control conditions | no estimate extracted | NR | No studies |