Leader: Fabrizia Lattanzio (INRCA); Other collaborator(s): Antonio Cherubini (INRCA); Giuseppe Sergi (UNIPD)
Interventions aimed at multimorbid older subjects with limited life expectancy, such as those with concomitant frailty or disability, should be primarily aimed at maximizing functional status and quality of life. The aim of this task will be to perform a systematic search of the literature concerning both older multimorbid patient’s preferences in terms of expected benefits from an intervention and expert views on this topic, summarizing the studies that from different perspectives have addressed this area. The results of the search will be discussed with a multidisciplinary panel, including patients and their organizations, to achieve a consensus on the preferable outcomes to consider when designing interventions targeting multimorbid older patients with frailty or disability.
Brief description of the activities and of the intermediate results: In November 2023 the screening of 4492 titles and abstracts for identifying scientific paper to be included in the systematic review was completed using the COVIDENCE platform. There was a disagreement between two reviewers for 453 articles. Senior reviewers Prof Antonio Cherubini, Dr. Marco Baccini and Prof. Francesca Cecchi were then involved in the conflicts resolution. After the preliminary screening procedures, 216 papers were considered for the full text screening that started in December 2023. Two groups (MF and CC, PB and DL) evaluated in double blind, 108 full text per group. Conflicts were examined by the 3 expert reviewers (AC, MB, FC). In the end 74 full text papers were included.
Main policy, industrial and scientific implications: These activities will be useful to design new intervention for older frail multimorbid patients considering their preferences, and the preferable outcomes.
After a preliminary screening of 4488 articles identified by multiple databases search (PubMed, Scopus, CINAHL, WoS, Embase) 74 studies were eligible for the full text reviews. During this quarter, four independent raters began the quality assessment of these 74 papers and started collecting the study outcomes in a dedicated database.
The quality assessment and the collection of the study outcomes in a dedicated database were completed. Preliminary results were presented to the EUGMS congress, in Valencia (Spain) in September. In particular, we evaluated outcomes most frequently assessed in randomized clinical trials that were: health-related quality of life (15/22studies); health care utilization (11/22studies); self-efficacy in disease management (8/22studies); mental health (6/22studies); drug use (5/22studies); treatment burden (4/22studies); self-rated health (2/22studies); satisfaction and independence with daily activities (2/22studies); mortality (2/22studies).
Since the previous bibliographic search dated back to July 2023, it was decided to carry out a new search from July 2023 to November 2024, in order to identify possible further papers of interest. Once the review of the articles included in the second bibliographic search, updated to last year, was completed, the outcomes heterogeneously represented in the different studies were grouped into 6 predefined categories in line with previous literature on this topic (Physical conditions/outcomes; Mental conditions/outcomes, Psychosocial outcomes/general health; Health care utilization and costs; Patient behaviours; Care process outcome) with the support of a methodologist. A manuscript draft reporting the main findings of our literature review was drawn to be shared with all the members of the spoke.
Dissemination
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