Decision aids for the care of patients with multimorbidity: a systematic review

BMC Family Practice, Nov 2025

Patients with multimorbidity face complex decision-making needs, including decreasing polypharmacy burden, maintaining physical functioning and prolonging life. Patient decision aids (DAs) have been developed and implemented as clinical tools to support complex decision-making in the management of multimorbidity in primary care. This study aimed to identify DAs developed for patients with multimorbidity, describe their characteristics, and assess their quality, feasibility, and effectiveness. Citations from searches of nine databases were screened by title and abstract, and then full text articles were subsequently identified and screened. Any article utilising a DA for patients with multimorbidity was eligible. The International Patient Decision Aid Standards (IPDAS) checklist was used to assess the quality of DAs. The characteristics, quality, feasibility and effectiveness of DAs were summarized using descriptive methods. In total, 10 articles including six DAs were included. The DAs were categorised as targeting either general multimorbidity or specific disease-combined multimorbidity. All included DAs need to be discussed and used together by general practitioners (GPs) and patients with multimorbidity. Four DAs focused on goal setting or preparing for physician-patient conversation in primary care settings. According to IPDAS evaluations, only one DA was rated as high-quality; the others were considered substandard, largely due to a lack of detail on decision trade-offs. Two DAs demonstrated good feasibility, but one showed feasibility only among clinicians and the other only among patients. For the effectiveness of DAs, two DAs was evaluated. One based on the quality of communication and collaboration in encounter and adherence to prescription medication, and the other the other based on the overall level of SDM or in patient-reported outcomes (such as decisional conflict). The evidence of effectiveness was very limited in the current studies. This study identified six DAs for patients with multimorbidity, five of which lacked descriptions of the consequences of the options and their positive and negative features. The evidence for feasibility and effectiveness of current DAs is limited. High-quality experimental research should be conducted in the future to verify effectiveness.

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Decision aids for the care of patients with multimorbidity: a systematic review

Metadata of the article that will be visualized online ArticleTitle Decision aids for the care of patients with multimorbidity: a systematic review Article CopyRight - Year Corresponding Author The Author(s) 2025 Family Name Yang Particle Author Given Name Chen Organization Sun Yat-sen University Address 74 Zhongshan 2nd Road, Yuexiu District Guangzhou Guangzhou Guangdong 510080, China Division School of Nursing Email Family Name Chen Particle Given Name Yuanxin Organization Sun Yat-sen University Address 74 Zhongshan 2nd Road, Yuexiu District Guangzhou Guangzhou Guangdong 510080, China Division School of Nursing Email Author Family Name He Particle Given Name Rui Organization Sun Yat-sen University Address 74 Zhongshan 2nd Road, Yuexiu District Guangzhou Guangzhou Guangdong 510080, China Division School of Nursing Email Author Family Name Chen Particle Given Name Zhiyi Organization Sun Yat-sen University Address 74 Zhongshan 2nd Road, Yuexiu District Guangzhou Guangzhou Guangdong 510080, China Division School of Nursing Email Author Family Name Bai Particle Given Name Yang Organization Sun Yat-sen University Address 74 Zhongshan 2nd Road, Yuexiu District Guangzhou Guangzhou Guangdong 510080, China Division School of Nursing Email Schedule Received 9 June 2025 Revised Accepted 16 October 2025 Abstract Background Patients with multimorbidity face complex decision-making needs, including decreasing polypharmacy burden, maintaining physical functioning and prolonging life. Patient decision aids (DAs) have been developed and implemented as clinical tools to support complex decision-making in the management of multimorbidity in primary care. Aim This study aimed to identify DAs developed for patients with multimorbidity, describe their characteristics, and assess their quality, feasibility, and effectiveness. Methods Citations from searches of nine databases were screened by title and abstract, and then full text articles were subsequently identified and screened. Any article utilising a DA for patients with multimorbidity was eligible. The International Patient Decision Aid Standards (IPDAS) checklist was used to assess the quality of DAs. The characteristics, quality, feasibility and effectiveness of DAs were summarized using descriptive methods. Results In total, 10 articles including six DAs were included. The DAs were categorised as targeting either general multimorbidity or specific disease-combined multimorbidity. All included DAs need to be discussed and used together by general practitioners (GPs) and patients with multimorbidity. Four DAs focused on goal setting or preparing for physician-patient conversation in primary care settings. According to IPDAS evaluations, only one DA was rated as high-quality; the others were considered substandard, largely due to a lack of detail on decision trade-offs. Two DAs demonstrated good feasibility, but one showed feasibility only among clinicians and the other only among patients. For the effectiveness of DAs, two DAs was evaluated. One based on the quality of communication and collaboration in encounter and adherence to prescription medication, and the other the other based on the overall level of SDM or in patient-reported outcomes (such as decisional conflict). The evidence of effectiveness was very limited in the current studies. Conclusions This study identified six DAs for patients with multimorbidity, five of which lacked descriptions of the consequences of the options and their positive and negative features. The evidence for feasibility and effectiveness of current DAs is limited. High-quality experimental research should be conducted in the future to verify effectiveness. Keywords(seperated by –) Decision aids– Multimorbidity– Shared decision making– Patient-centred care– BMC Primary Care Chen et al. BMC Primary Care (2025) 26:370 https://doi.org/10.1186/s12875-025-03082-8 Open Access RESEARCH Decision aids for the care of patients with multimorbidity: a systematic review Yuanxin Chen1, Rui He1, Zhiyi Chen1, Yang Bai1 and Chen Yang1* AQ1 F Abstract Background Patients with multimorbidity face complex decision-making needs, including decreasing polypharmacy burden, maintaining physical functioning and prolonging life. Patient decision aids (DAs) have been developed and implemented as clinical tools to support complex decision-making in the management of multimorbidity in primary care. Aim This study aimed to identify DAs developed for patients with multimorbidity, describe their characteristics, and assess their quality, feasibility, and effectiveness. Methods Citations from searches of nine databases were screened by title and abstract, and then full text articles were subsequently identified and screened. Any article utilising a DA for patients with multimorbidity was eligible. The International Patient Decision Aid Standards (IPDAS) checklist was used to assess the quality of DAs. The characteristics, quality, feasibility and effectiveness of DAs were summarized using descriptive methods. Results In total, 10 articles including six DAs were included. The DAs were categorised as targeting either general multimorbidity or specific disease-combined multimorbidity. All included DAs need to be discussed and used together by general practitioners (GPs) and patients with multimorbidity. Four DAs focused on goal setting or preparing for physician-patient conversation in primary care settings. According to IPDAS evaluations, only one DA was rated as high-quality; the others were considered substandard, largely due to a lack of detail on decision tradeoffs. Two DAs demonstrated good feasibility, but one showed feasibility only among clinicians and the other only among patients. For the effectiveness of DAs, two DAs was evaluated. One based on the quality of communication and collaboration in encounter and adherence to prescription medication, and the other the other based on the overall level of SDM or in patient-reported outcomes (such as decisional conflict). The evidence of effectiveness was very limited in the current studies. Conclusions This study identified six DAs for patients with multimorbidity, five of which lacked descriptions of the consequences of the options and their positive and negative features. The evidence for feasibility and effectiveness of current DAs is limited. High-quality experimental research should be conducted in the future to verify effectiveness. Keywords Decision aids, Multimorbidity, Shared decision making, Patient-centred care O D E O R P T C E R R O C N U *Correspondence: Chen Yang 1 School of Nursing, Sun Yat-sen University, 74 Zhongshan 2nd Road, Yuexiu District Guangzhou, Guangzhou, Guangdong 510080, China © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sh (...truncated)


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Chen, Yuanxin, He, Rui, Chen, Zhiyi, Bai, Yang, Yang, Chen. Decision aids for the care of patients with multimorbidity: a systematic review, BMC Family Practice, 2025, pp. 370, Volume 26, Issue 1, DOI: 10.1186/s12875-025-03082-8