Influences on Care Preferences of Older People with Advanced Illness: A Systematic Review and Thematic Synthesis |
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| Authors: | Simon N. Etkind MB BChir Anna E. Bone MPH Natasha Lovell MB ChB Irene J. Higginson PhD Fliss E. M. Murtagh PhD |
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| Affiliation: | 1. Cicely Saunders Institute of Palliative Care Policy and Rehabilitation, Kings College London, London, UK;2. Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK |
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| Abstract: | Objectives To determine and explore the influences on care preferences of older people with advanced illness and integrate our results into a model to guide practice and research. Design Systematic review using Medline, Embase, PsychINFO, Web of Science, and OpenGrey databases from inception to February 2017 and reference and citation list searching. Included articles investigated influences on care preference using qualitative or quantitative methodology. Thematic synthesis of qualitative articles and narrative synthesis of quantitative articles were undertaken. Setting Hospital and community care settings. Participants Older adults with advanced illness, including people with specific illnesses and markers of advanced disease, populations identified as in the last year of life, or individuals receiving palliative care (N = 15,164). Measurements The QualSys criteria were used to assess study quality. Results Of 12,142 search results, 57 articles were included. Family and care context, illness, and individual factors interact to influence care preferences. Support from and burden on family and loved ones were prominent influences on care preferences. Mechanisms by which preferences are influenced include the process of trading‐off between competing priorities, making choices based on expected outcome, level of engagement, and individual ability to form and express preferences. Conclusion Family is particularly important as an influence on care preferences, which are influenced by complex interaction of family, individual, and illness factors. To support preferences, clinicians should consider older people with illnesses and their families together as a unit of care. |
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| Keywords: | systematic review patient preference terminally ill terminal care palliative care |
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