Making patient values visible in healthcare: a systematic review of tools to assess patient treatment priorities and preferences in the context of multimorbidity

Authors : Dee Mangin, Gaibrie Stephen, Verdah Bismah, Cathy Risdon

Abstract

Objectives

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 multimorbidity. To examine the data for all identified tools with respect to validity, acceptability and effect on health outcomes.

Design Systematic Review.

Data sources MEDLINE, EMBASE and Cochrane databases, each with a predefined search strategy.

Eligibility criteria

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.

Results

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.

Conclusions

Given the importance of eliciting patient priorities and preferences in providing patient-centred care in the context of multimorbidity 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 multimorbidity. 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.

Citation: Dee Mangin, Gaibrie Stephen, Verdah Bismah, Cathy Risdon Making patient values visible in healthcare: a systematic review of tools to assess patient treatment priorities and preferences in the context of multimorbidity
BMJ Open 2016;6:e010903 doi:10.1136/bmjopen-2015-010903

Received: 17 December 2015 Revised: 29 March 2016 Accepted: 12 May 2016 Published: 10 June 2016

Copyright: This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

Contributors DM conceived the review and was responsible for the overall design. DM, GS and VB designed the detailed search strategy. GS and VB extracted the data. GS VB and DM screened and analysed the data. DM, GS, VB and CR interpreted the analysis, wrote the paper and contributed to revisions.

Funding VB was a summer student at the Department of Family Medicine, McMaster University, and was funded by a MacWork student bursary and the David Braley Nancy Gordon Chair in Family Medicine. Jenna Parascandalo is funded by the David Braley Nancy Gordon Chair in Family Medicine. DM's work is supported by the David Braley Nancy Gordon Chair in Family Medicine.

Competing interests None declared.

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