Summary of findings 2. Interventions for involving patients in decision‐making about their health care compared to attention‐control conditions for older patients with multi‐morbidity.

Interventions for involving patients in decision‐making about their health care compared to attention‐control conditions for older patients with multi‐morbidity
Patient or population: older patients with multi‐morbidity Setting: primary care Intervention: interventions for involving patients in decision‐making about their health care (patient workshop and individual coaching, individual patient coaching) Comparison: attention‐control conditions
Outcomes	Anticipated absolute effects* (95% CI)		Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
	Risk with attention‐control conditions	Risk with interventions for involving patients in decision‐making about their health care
Patient involvement in decision‐making (primary outcome) Not measured			‐	‐	‐	No studies were found that measured patient involvement in decision‐making
Health status Patient‐reported high self‐rated health at 6 months after baseline. Hochhalter used CDC Healthy Days Measure (CDC 2000); Reed used a similar 5‐point Likert scale developed by the US National Health and Nutrition Examination Survey; each scale was dichotomised as low (1 to 3) and high (4 to 5) Higher score shows improvement	Hochhalter 2010 reported fewer intervention participants reported high self‐rated health when compared to attention‐control participants at 6 months (RR 0.38, 95% CI 0.15 to 1.00; P = 0.05). Conversely, Reed 2018 reported more intervention participants reported high self‐rated health than attention‐control participants at 6 months (RR 2.17, 95% CI 0.85 to 5.52; P = 0.11) Results were not pooled due to high heterogeneity between studies and opposite directions of effect		‐	297 (2 RCTs)	⊕⊝⊝⊝ VERY LOWa,b,c,d	We are uncertain whether involving patients in decision‐making about their health care either increases or decreases reports of high self‐rated health for older patients with multi‐morbidity
Patient enablement and engagement (a) Patient activation at 6 months after baseline. Patient Activation Measure score (13‐item assessment of knowledge and confidence related to participation in care. Responses on a 4‐point scale are summed and converted to an ‘Activation Score’ from 0 to 100) (Hibbard 2005) Higher score shows improvement	Mean Patient Activation Measure score was 65.6	MD 1.2 higher (8.21 lower to 10.61 higher)	‐	43 (1 RCT)	⊕⊝⊝⊝ VERY LOWa,e,f,g	We are uncertain whether interventions for involving patients in decision‐making about their health care change Patient Activation Measure scores for older patients with multi‐morbidity
Patient enablement and engagement (b) Self‐efficacy at 6 months after baseline (self‐efficacy for managing chronic disease scale assessed from scores on 6 items rated 1 ‘not at all confident’ to 10 ‘totally confident’) (Stanford 2018) Higher score shows improvement	Mean self‐efficacy rating was 6.26	MD 0.29 higher (0.21 lower to 0.79 higher)	‐	254 (1 RCT)	⊕⊝⊝⊝ VERY LOWe,f,g	We are uncertain whether interventions for involving patients in decision‐making about their health care either increase or decrease self‐efficacy for older patients with multi‐morbidity
Patient evaluation of care/the intervention Patient reports that the intervention changed management of his or her health at 6 months after baseline (3‐point scale: dichotomised into 'a great deal' vs 'somewhat' + 'not at all') (Stanford 2018) Higher score shows improvement	Study population		RR 1.82 (1.35 to 2.44)	231 (1 RCT)	⊕⊕⊝⊝ LOWf,g	Involving older patients with multi‐morbidity in decision‐making about their care may increase patient reports of changed management of their health
	333 per 1000	607 per 1000 (450 to 813)
Practitioners' knowledge and skills Not measured			‐	‐	‐	No studies were found that looked at practitioners' knowledge and skills
Resource use and cost Number of general practice visits in the 6 months following baseline (patient self‐report via questionnaire)	Mean number of self‐reported general practice visits was 4.82	MD 0.51 higher (0.34 lower to 1.36 higher)	‐	254 (1 RCT)	⊕⊝⊝⊝ VERY LOWf,g,h,i	We are uncertain whether involving patients in decision‐making about their health care changes the number of general practice visits reported by older patients with multi‐morbidity
Adverse event** Less patient involvement as a result of the intervention Not measured			‐	‐	‐	No studies were found that looked at less patient involvement as a result of the intervention
*The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). The assumed risk in the comparison group is the mean risk from the comparison groups in included studies. **Reed 2018 reported no difference between intervention and usual care groups in numbers of hospital admissions and in numbers of accident and emergency department visits. CDC: Centers for Disease Control and Prevention; CI: confidence interval; MD: mean difference; RCT: randomised controlled trial; RR: risk ratio.
GRADE Working Group grades of evidence. High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.

^aUnclear performance bias, detection bias, and reporting bias have the potential to affect the outcome; however, not considered 'serious' risk (certainty not downgraded for risk of bias).

^bHigh heterogeneity with effects in opposite directions (certainty downgraded ‐1 for inconsistency).

^cSmall sample size, no. of events < 300 (certainty downgraded ‐2 for imprecision).

^dResults from two small studies in a developing evidence base (certainty downgraded ‐1 for indirectness).

^eAll results from the same small study in a developing evidence base (certainty downgraded ‐1 for indirectness).

^fSmall sample size, no. of participants < 400 (certainty downgraded ‐1 for imprecision).

^g95% confidence intervals include no effect and may cross the minimally important difference (certainty downgraded ‐1 for imprecision).

^hPatient self‐report as opposed to objective measure (certainty downgraded ‐1 for risk of bias (blinding)).