Collaborative goal setting with elderly patients with chronic disease or multimorbidity: a systematic review
Collaborative goal setting with elderly patients with chronic disease or multimorbidity: a systematic review
复制标题
与患有慢性病或多病的老年患者合作设定目标：系统评价
作者：
Neeltje P Vermunt;M. Harmsen;G. Westert;M. O. Olde Rikkert;M. Faber
背景与患有慢性疾病或特别是多发病的患者共享决策是一项具有挑战性的工作。因此，以患者目标为导向的方法可能是有益的。本研究旨在识别和评估与常规护理相比，支持协作性目标设定或健康优先设定的干预对患有慢性健康状况或多发性疾病的老年人的效果。方法基于EPOC、PRISMA和MOOSE指南。系统检索PubMed、mental Info、CINAHL、Web of Science、Embase和Cochrane Central Register of Control Trials。采用以下资格标准：1.随机(集群)对照试验、非随机对照试验、前后对照研究、中断时间序列或重复测量研究设计；2.专门针对协作目标设定或健康优先设定的单一干预或包括这些因素的多因素干预；3.多病或至少一种慢性病患者的研究人群(平均年龄±标准差(SD)包括)。65岁)。4.关于可归结为协作性目标设定或健康优先设定结果的结果测量的研究。确定了描述五种独特干预措施的八篇文章，其中包括四项群集性随机对照试验和一项随机对照试验。分别代表904名、183名、387名和1921名患者的4项干预研究是多因素的，在目标设定(慢性病护理患者评估目标设定子量表)的应用、提前指示的数量或将目标纳入护理计划方面显示出统计学上的显著影响。在这些多因素干预中，专业人员对目标设置或优先设置的明确关注是一个共同的因素。其中一项研究对322名患者实施了单因素干预，但对医患协议没有显著影响。所有研究都有不同程度的方法论问题。结论协作性目标设定和/或优先次序设定可能最能整合到复杂的护理干预中。进一步的研究应该确定多因素干预中基本要素的组合，以便为日常实践提供建议。此外，必须强调方法创新和应用混合评价模式的必要性，以应对目标设定和(或)优先设定干预研究的复杂性。
BackgroundIt is challenging to use shared decision-making with patients who have a chronic health condition or, especially, multimorbidity. A patient-goal-oriented approach can thus be beneficial. This study aims to identify and evaluate studies on the effects of interventions that support collaborative goal setting or health priority setting compared to usual care for elderly people with a chronic health condition or multimorbidity.MethodsThis systematic review was based on EPOC, PRISMA and MOOSE guidelines. Pubmed, PsychInfo, CINAHL, Web of Science, Embase and the Cochrane Central Register of Controlled Trials were searched systematically. The following eligibility criteria were applied: 1. Randomised (cluster) controlled trials, non-randomised controlled trials, controlled before-after studies, interrupted time series or repeated measures study design; 2. Single intervention directed specifically at collaborative goal setting or health priority setting or a multifactorial intervention including these elements; 3. Study population of patients with multimorbidity or at least one chronic disease (mean age ± standard deviation (SD) incl. age 65). 4. Studies reporting on outcome measures reducible to outcomes for collaborative goal setting or health priority setting.ResultsA narrative analysis was performed. Eight articles describing five unique interventions, including four cluster randomised controlled trials and one randomised controlled trial, were identified. Four intervention studies, representing 904, 183, 387 and 1921 patients respectively, were multifactorial and showed statistically significant effects on the application of goal setting (Patient Assessment of Chronic Illness Care (PACIC) goal setting subscale), the number of advance directives or the inclusion of goals in care plans. Explicit attention for goal setting or priority setting by a professional was a common element in these multifactorial interventions. One study, which implemented a single-factor intervention on 322 patients, did not have significant effects on doctor-patient agreement. All the studies had methodological concerns in varying degrees.ConclusionsCollaborative goal setting and/or priority setting can probably best be integrated in complex care interventions. Further research should determine the mix of essential elements in a multifactorial intervention to provide recommendations for daily practice. In addition, the necessity of methodological innovation and the application of mixed evaluation models must be highlighted to deal with the complexity of goal setting and/or priority setting intervention studies.
影响因子：
120.7
作者：
Tinetti, Mary E.;Fried, Terri R.;Boyd, Cynthia M.
通讯作者：
Boyd, Cynthia M.
指导护理对家庭护理人员的影响。
DOI：
10.1093/geront/gnp124
发表时间：
2010
期刊：
The Gerontologist
影响因子：
--
作者：
Wolff,JenniferL;Giovannetti,ErinR;Boyd,CynthiaM;Reider,Lisa;Palmer,Sara;Scharfstein,Daniel;Marsteller,Jill;Wegener,StephenT;Frey,Katherine;Leff,Bruce;Frick,KevinD;Boult,Chad
通讯作者：
Boult,Chad