Abstract
Creating a treatment plan (TP) through shared decision-making (SDM) with healthcare professionals is of paramount importance for patients with multimorbidity (MM). This study aims to estimate the prevalence of SDM and TP in patients with MM and study the association between SDM/TP with patients' confidence to manage their diseases and hospitalization within the previous 1year. This cross-sectional study used an internationally recognized survey. A total of 1032 patients aged 60 or above with MM were recruited from a specialist outpatient clinic, general outpatient clinic (GOPC) and a geriatric day hospital. The proportion of patients reported to have SDM and TP was estimated. Associations between the presence of SDM/TP and patients' demographic data, the confidence level to manage their illnesses and hospitalization in previous 1year were then studied using logistic regression. The prevalence of SDM and TP was 35.8% and 82.1%, respectively. The presence of TP was associated with receiving healthcare from the same doctor or in the same facilities and being recruited from GOPC. The presence of SDM (OR=1.352, P=.089) and TP (OR=2.384, P<.001) was associated with enhanced confidence in dealing with diseases. Most people with MM had TP in Hong Kong, but fewer patients had SDM. Ways to promote SDM in HK are needed.
Highlights
Creating a treatment plan (TP) through shared decision making (SDM) with healthcare professionals, is of paramount importance for patients with multimorbidity
This study aims to estimate the prevalence of SDM and TP in patients with multimorbidity, and study the association between SDM/TP with demographics and patients’ confidence to manage their diseases.Method This cross-sectional study used an internationally recognized survey. 1,032 patients aged 60 or above with multimorbidity, were recruited from a specialist outpatient clinic, general outpatient clinic (GOPC) and a geriatric day hospital
Shared decision making(SDM) is defined as ‘an approach in which the clinician and patient go through all phases of the decision making process together and in which they share the preference for treatment and reach an agreement on treatment choice’; this is in contrast to the traditional medical model where doctors are solely responsible for prescribing the ‘best’ treatment to patients[17]
Summary
Creating a treatment plan (TP) through shared decision making (SDM) with healthcare professionals, is of paramount importance for patients with multimorbidity. This study aims to estimate the prevalence of SDM and TP in patients with multimorbidity, and study the association between SDM/TP with demographics and patients’ confidence to manage their diseases.Method This cross-sectional study used an internationally recognized survey. Associations between the presence of SDM/TP and patients’ demographic data, and the confidence level to manage their illnesses, were studied using logistic regression.Results The prevalence of SDM and TP were 35.8% and 82.1%, respectively. Instead of following clinical guidelines, the American Geriatric Society[15] and The National Institute for Health and Care Excellence(NICE)[16] recommended a shared decision process to individualize a treatment plan that is in accordance with patients’ preferences and values, and this may minimize treatment burden and maximize quality of life. While there were previous studies in Hong Kong investigating SDM in other patient populations, including do-not-resuscitate decisions in patients with chronic obstructive lung diseases and in surgical and medical patients[19,20], the prevalence of SDM and TP in patients with MM, who could benefit most from SDM in Hong Kong, was not previously known
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