Table 1.

A comparison of our proposed review with existing systematic reviews of similar interventions

Systematic review	Structure	Processes	Outcomes
Interventions for improving outcomes in patients with multimorbidity in primary care and community settings. Smith 2016	Smith 2016 excluded interventions that included people with comorbid conditions where the intervention was targeted solely at one condition. We will include studies where older people with multimorbidity were exposed to an intervention to facilitate patient involvement in their healthcare, and where outcomes were reported in respect of this population, even if the intervention was not originally designed for older patients with multimorbidity	Smith 2016 did not design their search strategy to find studies of interventions to facilitate the involvement of older patients with multimorbidity in decision‐making about their care, which is the aim of our review. Smith 2016 was not specifically interested in the processes within, and supporting, a general practice consultation, which is the focus of our review	Our review will differ from Smith 2016 as our primary outcome, of whether or not patient involvement in the decision‐making process occurred during a consultation, was not a primary outcome, or a specific focus of a secondary outcome, in Smith 2016. Smith 2016 excluded the outcomes of attitude and knowledge when reporting studies, both of which are highly relevant to the delivery of patient‐centred care, and to patient involvement in decision‐making about their healthcare during a primary care consultation. Our review will include these outcomes in order to inform clinicians and policy makers about interventions supporting improved patient knowledge of their conditions and treatments, improved patient enablement for self‐care, positive changes in patients’ health beliefs and lifestyle choices, patient satisfaction with healthcare and trust in the practitioner, and improved practitioner communication skills including shared‐decision making. Attitudes towards the intervention and compliance with it will also be important in the development of future interventions to facilitate the involvement of older patients with multimorbidity in decision‐making about their healthcare
Interventions for providers to promote a patient‐centred approach in clinical consultations. Dawmena 2012	Dawmena 2012 included studies of interventions facilitating shared decision‐making, however they focus only on studies of interventions directed at healthcare professionals, or at healthcare professionals and patients together. Our review would additionally include studies of interventions targeting only patients, and in particular the very important and vulnerable patient population of older patients with multimorbidity	‐	‐
Personalised care planning for adults with chronic or long‐term health conditions. Coulter 2015	The type of care planning evaluated by Coulter 2015 does not routinely take place within a primary care consultation alone, being more likely to be initiated by a secondary care specialist liasing with the primary care team. Primary care will be the focus of our review	Coulter 2015 looked at personalised care planning and their inclusion criteria captures a subset of studies evaluating elements of patient involvement in decision‐making. Our review criteria are much broader in terms of studies to facilitate patient involvement	‐
Interventions before consultations for helping patients address their information needs. Kinnersley 2008	Kinnersley 2008 focused on interventions targeted only at patients, whereas we are interested in interventions aimed at patients, practitioners, or both, as well as any elements of organisational change	Kinnersley 2008 looked at studies of interventions to support patients in information gathering from a doctor or a nurse during a consultation. Whilst this is an important aspect of patient involvement, it is only one element of a complex process. We therefore feel that the inclusion criteria used in this review will have missed many studies that are of relevance to our review	‐
Interventions for improving the adoption of shared decision making by healthcare professionals. Légaré 2018	This review covers an important topic in the research area of shared decision‐making. However, it focuses only on studies of interventions designed to improve the healthcare professional’s adoption of shared decision‐making and excludes many studies focusing on patient‐mediated involvement in decision‐making	‐	‐
Interventions for improving patients' trust in doctors and groups of doctors. Rolfe 2014	‐	We know from our own work that there are associations between patients’ trust in the doctor and their involvement in decision‐making about their care. Studies of interventions to promote patient involvement in decision‐making would be included by Rolfe 2014. However the scope of this review is very broad and it does not address our aim; to systematically review studies of interventions that facilitate patient involvement, focusing on older people with multimorbidity	‐