Abstract
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.
Highlights
End-of-life (EoL) care is generally defined as the care provided to patients in the last year of life, for some conditions, it may last for several years [1]
We based the review on a knowledge cluster of EoL care preferences that we previously identified for an evidence map we developed on health-related preferences in older patients with multimorbidity [8]
The results showed that a mean proportion of 21% of older patients with multimorbidity were willing to receive life-sustaining treatments (LSTs) regardless of the scenario authors presented to them
Summary
End-of-life (EoL) care is generally defined as the care provided to patients in the last year of life, for some conditions, it may last for several years [1]. Patients living with multimorbidity (i.e., two or more concomitant chronic conditions) and life-limiting chronic diseases, as well as their loved ones and health professionals, are often confronted with decisions concerning EoL care [2]. The unpredictable trajectories of disease in older patients with multimorbidity make it important that patients and providers discuss EoL care preferences at an early stage [3]. Advance care planning (ACP) describes a voluntary and ongoing discussion of EoL care preferences by patients, their families and health professionals [4]. To provide decision support to health professionals and help this complex patient population in an emotionally difficult situation, we systematically reviewed EoL care preferences in older patients with multimorbidity. We based the review on a knowledge cluster of EoL care preferences that we previously identified for an evidence map we developed on health-related preferences in older patients with multimorbidity [8]
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