Abstract
Introduction: Clinical decision making for older adults with multimorbidity can be complex and demanding. When facing complex decision-making, patients may experience decisional conflicts, leading to low treatment adherence, adverse health outcomes, and increased utilization of health services, etc. To address these issues, patient decision aids (DAs) have been developed and utilized in the decision-making process to facilitate informed decisions. The aim of this study is to identify DAs developed for patients with multimorbidity and assess their quality.
Method: We searched full-text papers on nine databases. Any article utilizing a DA for patients with multimorbidity was eligible and DAs for making medical decisions at any point were eligible. We used the International Patient Decision Aid Standards (IPDAS) checklist to assess the quality of DAs.
Results： In total, ten articles including six DAs were included. Two DAs targeted for the older patients with multimorbidity. Most DAs didn’t focus on specific treatment choices but rather aimed at improving the overall quality of life for patients with multimorbidity. The targets of these DAs are including setting goals about health care, preparing for conversation with doctors and taking ownership for the decisions. IPDAS checklist revealed that only one DA met all qualifying criteria and provided comprehensive choice. Three DAs were deemed to have poor quality due to their failure to provide the pros and cons of decisions. The quality of the remaining DAs was difficult to judge due to incomplete versions.
Conclusions: DAs for patients with multimorbidity were few and had poor quality. Designing DAs for this patient population presents challenges given the complex nature of multimorbidity and its lack of specific treatment options. Future development should focus on adhering to the IPDAS checklist, provide more information and possibility, and aim at improving the quality of life for patients with multimorbidity.