End-of-Life Care Preferences of Older Patients with Multimorbidity: A Mixed Methods Systematic Review

Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79110 Freiburg, Germany

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Department of Public Health and Primary Care, Leiden University Medical Center, 2300 RC Leiden, The Netherlands

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Department of Family Medicine, School CAPHRI, Maastricht University, 6200 Maastricht, The Netherlands

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Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, 3000 Leuven, Belgium

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Patient Representative, Federal Joint Committee “Gemeinsamer Bundseausschuss”, 10587 Berlin, Germany

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Center for Adaptive Rationality, Max Planck-Institute for Human Development, 14195 Berlin, Germany

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Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD 4226, Australia

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Department of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada

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Cochrane Germany, Cochrane Germany Foundation, 79110 Freiburg, Germany

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Department of General Practice and Family Medicine, Medical Faculty OWL, University of Bielefeld, 33615 Bielefeld, Germany

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J. Clin. Med. 2021, 10(1), 91; https://doi.org/10.3390/jcm10010091

Received: 2 December 2020 / Revised: 23 December 2020 / Accepted: 24 December 2020 / Published: 29 December 2020

(This article belongs to the Special Issue Multimorbidity Development and Evolution: Clinical Implications)

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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. View Full-Text

Keywords: end of life care; patient preferences; multimorbidity; elderly; patient centered care

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MDPI and ACS Style

González-González, A.I.; Schmucker, C.; Nothacker, J.; Nury, E.; Dinh, T.S.; Brueckle, M.-S.; Blom, J.W.; van den Akker, M.; Röttger, K.; Wegwarth, O.; Hoffmann, T.; Gerlach, F.M.; Straus, S.E.; Meerpohl, J.J.; Muth, C. End-of-Life Care Preferences of Older Patients with Multimorbidity: A Mixed Methods Systematic Review. J. Clin. Med. 2021, 10, 91. https://doi.org/10.3390/jcm10010091

AMA Style

González-González AI, Schmucker C, Nothacker J, Nury E, Dinh TS, Brueckle M-S, Blom JW, van den Akker M, Röttger K, Wegwarth O, Hoffmann T, Gerlach FM, Straus SE, Meerpohl JJ, Muth C. End-of-Life Care Preferences of Older Patients with Multimorbidity: A Mixed Methods Systematic Review. Journal of Clinical Medicine. 2021; 10(1):91. https://doi.org/10.3390/jcm10010091

Chicago/Turabian Style

González-González, Ana I., Christine Schmucker, Julia Nothacker, Edris Nury, Truc Sophia Dinh, Maria-Sophie Brueckle, Jeanet W. Blom, Marjan van den Akker, Kristian Röttger, Odette Wegwarth, Tammy Hoffmann, Ferdinand M. Gerlach, Sharon E. Straus, Joerg J. Meerpohl, and Christiane Muth. 2021. "End-of-Life Care Preferences of Older Patients with Multimorbidity: A Mixed Methods Systematic Review" Journal of Clinical Medicine 10, no. 1: 91. https://doi.org/10.3390/jcm10010091

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