1. Comparison of our proposed review with existing systematic reviews of similar interventions.
| Systematic review | Structure | Processes | Outcomes |
| Interventions for improving outcomes in patients with multi‐morbidity in primary care and community settings (Smith 2016) | Smith 2016 excluded interventions that included people with comorbid conditions when the intervention was targeted solely at 1 condition. We will include studies in which older people with multi‐morbidity were exposed to an intervention to facilitate patient involvement in their health care, and in which outcomes were reported with respect to this population, even if the intervention was not originally designed for older patients with multi‐morbidity |
Smith 2016 did not design its search strategy to find studies of interventions to facilitate the involvement of older patients with multi‐morbidity 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 in terms of our primary outcome of whether or not patient involvement in the decision‐making process occurred during a consultation, was not a primary outcome, or was a specific focus of a secondary outcome. 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 health care during a primary care consultation. Our review will include these outcomes 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 health care 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 multi‐morbidity in decision‐making about their health care |
| 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, this study focuses 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, in particular, the very important and vulnerable patient population of older patients with multi‐morbidity | ‐ | ‐ |
| 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 but is more likely to be initiated by a secondary care specialist liaising with the primary care team. Primary care will be the focus of our review | Coulter 2015 looked at personalised care planning, and inclusion criteria for this study capture 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 1 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 multi‐morbidity | ‐ |