A systematic review of shared decision-making interventions to improve self-care in multimorbidity: Effects on patient-level and care delivery outcomes.

OBJECTIVES

Patients with multimorbidity experience unique self-care challenges as they manage multiple conditions simultaneously. Shared decision making is a potentially effective strategy to address these difficulties. However, systematic evidence for this population is limited. The purpose of this systematic review is to describe the components of shared decision-making interventions aimed at improving self-care for patients with multimorbidity and to synthesize evidence of intervention effectiveness related to patient-level and care delivery outcomes.

METHODS

A systematic literature search was performed in MEDLINE, EMBASE, Cochrane Library, CINAHL, PsycINFO, and trial registries. Experimental studies were included if they examined shared decision-making interventions aimed at improving self-care in adults with two or more chronic diseases. Patient-level outcomes were grouped into three categories: affective-cognitive, behavioral, and health. Methodological quality was evaluated with the Mixed Methods Appraisal Tool.

RESULTS

Among the initial 28,865 articles, six studies were included, with overall moderate methodological quality. Interventions mostly consisted of clinician preparation and implementation of a shared decision-making process before, during, and after a clinical encounter. No studies assessed affective-cognitive outcomes. Across the studies, interventions showed limited or inconsistent effects on behavioral and health outcomes. Effects on care delivery outcomes were also mixed, with patient-perceived shared decision making showing no improvement.

CONCLUSIONS

Evidence on shared decision-making interventions aimed at improving self-care in the context of multimorbidity remains limited, with existing interventions showing inconsistent or limited effects on both patient-level and care delivery outcomes.

PRACTICE IMPLICATIONS: A meaningful translation of shared decision making into multimorbidity care requires providing clinicians with practical, multimorbidity-specific deliberation support and strengthening patients' participation. Structured follow-up to revisit care plans and enhance patient activation is also needed to bridge the gap between care planning and behavior change.