Making Patient Values Visible In Healthcare—Reviewing Tools To Assess Patient Treatment Priorities And Preferences In The Context Of Multimorbidity: A Qualitative Case Study
To identify studies of existing instruments available for clinicians to record overall patient preferences and priorities for care, suitable for use in routine primary care practice in patients with multi-morbidity. To examine the data for all identified tools with respect to validity, acceptability and effect on health outcomes.
The analysis followed the design of a systematic review study.
MEDLINE, EMBASE and Cochrane databases (each with a predefined search strategy).
Citations were included if they reported a tool used to record patient priorities or preferences for treatment, and quantitative or qualitative results following administration of the tool.
We followed the MOOSE and PRISMA guidelines for meta-analyses and systematic reviews of observational studies in designing and reporting this study. Selection and inclusion criteria: We searched EMBASE, MEDLINE and the Cochrane Library to identify English language abstracts published up to January 2015. Search terms and strategy were determined by the investigators with advice from a librarian. We also used the Google search engine to identify articles in the grey literature, and manually searched reference lists of included and excluded articles for other articles of potential relevance.
Our search identified 189 potential studies of which 6 original studies and 2 discussion papers were included after screening for relevance. 5 of 6 studies (83%) were of cross-sectional design and of moderate quality. All studies reported on the usability of a tool in order to elicit patient preferences. No studies reported on changes to patient-specific healthcare outcomes as a consequence of recording preferences and priorities.
1 of 6 studies reported on eliciting patient preference in the context of multimorbidity. No studies incorporated patient preferences into an electronic medical record.
Given the importance of eliciting patient priorities and preferences in providing patient-centred care in the context of multi-morbidity and polypharmacy, we found surprisingly few relevant tools. Some aspects of the tools used for single disease contexts may also be useful in the context of multi-morbidity. There is an urgent need to develop ways to make patient priorities explicitly visible in the clinical record and medical decision-making and to test the effect on patient-relevant outcomes.
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