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End-of-Life Care Preferences of Older Patients with Multimorbidity: A Mixed Methods Systematic Review

Unpredictable disease trajectories make early clarification of end-of-life (EoL) care preferences in older patients with multimorbidity advisable. This mixed methods systematic review synthesizes studies and assesses such preferences. Two independent reviewers screened title/abstracts/full texts in...

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Autores principales: González-González, Ana I., Schmucker, Christine, Nothacker, Julia, Nury, Edris, Dinh, Truc Sophia, Brueckle, Maria-Sophie, Blom, Jeanet W., van den Akker, Marjan, Röttger, Kristian, Wegwarth, Odette, Hoffmann, Tammy, Gerlach, Ferdinand M., Straus, Sharon E., Meerpohl, Joerg J., Muth, Christiane
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7795676/
https://www.ncbi.nlm.nih.gov/pubmed/33383951
http://dx.doi.org/10.3390/jcm10010091
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author González-González, Ana I.
Schmucker, Christine
Nothacker, Julia
Nury, Edris
Dinh, Truc Sophia
Brueckle, Maria-Sophie
Blom, Jeanet W.
van den Akker, Marjan
Röttger, Kristian
Wegwarth, Odette
Hoffmann, Tammy
Gerlach, Ferdinand M.
Straus, Sharon E.
Meerpohl, Joerg J.
Muth, Christiane
author_facet González-González, Ana I.
Schmucker, Christine
Nothacker, Julia
Nury, Edris
Dinh, Truc Sophia
Brueckle, Maria-Sophie
Blom, Jeanet W.
van den Akker, Marjan
Röttger, Kristian
Wegwarth, Odette
Hoffmann, Tammy
Gerlach, Ferdinand M.
Straus, Sharon E.
Meerpohl, Joerg J.
Muth, Christiane
author_sort González-González, Ana I.
collection PubMed
description Unpredictable disease trajectories make early clarification of end-of-life (EoL) care preferences in older patients with multimorbidity advisable. This mixed methods systematic review synthesizes studies and assesses such preferences. Two independent reviewers screened title/abstracts/full texts in seven databases, extracted data and used the Mixed Methods Appraisal Tool to assess risk of bias (RoB). We synthesized findings from 22 studies (3243 patients) narratively and, where possible, quantitatively. Nineteen studies assessed willingness to receive life-sustaining treatments (LSTs), six, the preferred place of care, and eight, preferences regarding shared decision-making processes. When unspecified, 21% of patients in four studies preferred any LST option. In three studies, fewer patients chose LST when faced with death and deteriorating health, and more when treatment promised life extension. In 13 studies, 67% and 48% of patients respectively were willing to receive cardiopulmonary resuscitation and mechanical ventilation, but willingness decreased with deteriorating health. Further, 52% of patients from three studies wished to die at home. Seven studies showed that unless incapacitated, most patients prefer to decide on their EoL care themselves. High non-response rates meant RoB was high in most studies. Knowledge of EoL care preferences of older patients with multimorbidity increases the chance such care will be provided.
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spelling pubmed-77956762021-01-10 End-of-Life Care Preferences of Older Patients with Multimorbidity: A Mixed Methods Systematic Review González-González, Ana I. Schmucker, Christine Nothacker, Julia Nury, Edris Dinh, Truc Sophia Brueckle, Maria-Sophie Blom, Jeanet W. van den Akker, Marjan Röttger, Kristian Wegwarth, Odette Hoffmann, Tammy Gerlach, Ferdinand M. Straus, Sharon E. Meerpohl, Joerg J. Muth, Christiane J Clin Med Review Unpredictable disease trajectories make early clarification of end-of-life (EoL) care preferences in older patients with multimorbidity advisable. This mixed methods systematic review synthesizes studies and assesses such preferences. Two independent reviewers screened title/abstracts/full texts in seven databases, extracted data and used the Mixed Methods Appraisal Tool to assess risk of bias (RoB). We synthesized findings from 22 studies (3243 patients) narratively and, where possible, quantitatively. Nineteen studies assessed willingness to receive life-sustaining treatments (LSTs), six, the preferred place of care, and eight, preferences regarding shared decision-making processes. When unspecified, 21% of patients in four studies preferred any LST option. In three studies, fewer patients chose LST when faced with death and deteriorating health, and more when treatment promised life extension. In 13 studies, 67% and 48% of patients respectively were willing to receive cardiopulmonary resuscitation and mechanical ventilation, but willingness decreased with deteriorating health. Further, 52% of patients from three studies wished to die at home. Seven studies showed that unless incapacitated, most patients prefer to decide on their EoL care themselves. High non-response rates meant RoB was high in most studies. Knowledge of EoL care preferences of older patients with multimorbidity increases the chance such care will be provided. MDPI 2020-12-29 /pmc/articles/PMC7795676/ /pubmed/33383951 http://dx.doi.org/10.3390/jcm10010091 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
González-González, Ana I.
Schmucker, Christine
Nothacker, Julia
Nury, Edris
Dinh, Truc Sophia
Brueckle, Maria-Sophie
Blom, Jeanet W.
van den Akker, Marjan
Röttger, Kristian
Wegwarth, Odette
Hoffmann, Tammy
Gerlach, Ferdinand M.
Straus, Sharon E.
Meerpohl, Joerg J.
Muth, Christiane
End-of-Life Care Preferences of Older Patients with Multimorbidity: A Mixed Methods Systematic Review
title End-of-Life Care Preferences of Older Patients with Multimorbidity: A Mixed Methods Systematic Review
title_full End-of-Life Care Preferences of Older Patients with Multimorbidity: A Mixed Methods Systematic Review
title_fullStr End-of-Life Care Preferences of Older Patients with Multimorbidity: A Mixed Methods Systematic Review
title_full_unstemmed End-of-Life Care Preferences of Older Patients with Multimorbidity: A Mixed Methods Systematic Review
title_short End-of-Life Care Preferences of Older Patients with Multimorbidity: A Mixed Methods Systematic Review
title_sort end-of-life care preferences of older patients with multimorbidity: a mixed methods systematic review
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7795676/
https://www.ncbi.nlm.nih.gov/pubmed/33383951
http://dx.doi.org/10.3390/jcm10010091
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