Effects of goal-oriented care for adults with multimorbidity: A systematic review and meta-analysis

Angelo Barbato; Barbara D'Avanzo; Michela Cinquini; Andrea Veronica Fittipaldo; Alessandro Nobili; Laura Amato; Simona Vecchi; Graziano Onder

doi:10.1111/jep.13674

Effects of goal-oriented care for adults with multimorbidity: A systematic review and meta-analysis

J Eval Clin Pract. 2022 Jun;28(3):371-381. doi: 10.1111/jep.13674. Epub 2022 Mar 30.

Authors

Angelo Barbato¹, Barbara D'Avanzo¹, Michela Cinquini², Andrea Veronica Fittipaldo², Alessandro Nobili³, Laura Amato⁴, Simona Vecchi⁴, Graziano Onder⁵

Affiliations

¹ Department of Health Policy, Laboratory for Quality Assessment of Care and Services, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
² Department of Oncology, Laboratory of Clinical Research Methodology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
³ Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
⁴ Department of Epidemiology, Lazio Region-ASL Rome1, Rome, Italy.
⁵ Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy.

Abstract

Objective: To systematically review the evidence from randomized controlled trials comparing the effects of goal-oriented care against standard care for multimorbid adults.

Data sources/study setting: The literature presenting the results of randomized trials assessing the outcomes of goal-oriented care compared with usual care for adults with multimorbidity.

Study design: Systematic review and meta-analysis.

Data collection/extraction methods: We searched the Cochrane Database of Systematic Reviews (CENTRAL), EMBASE, MEDLINE, CINHAL, trial registries such as ClinicalTrial.gov and World Health Organization International Clinical Trials Registry Platform (ICTRP), and the references of eligible trials and relevant reviews. Goal-oriented care was defined as an approach that engages patients, establishes personal goals, and sets targets for patients and clinicians to plan a course of action and measure outcome. We reviewed 228 trials, and 12 were included. We extracted outcome data on quality of life, hospital admission, patients' satisfaction, patient and caregiver burden. Risk of bias was assessed and certainty of evidence was evaluated using GRADE.

Principal findings: No study was fully free of bias. No effect was found on quality of life (standardized mean difference [SMD]: 0.05; 95% CI: -0.05 to 0.16) and hospital admission (risk ratio [RR]: 0.87; 95% CI: 0.65 to 1.17). There was a very small effect for patients' satisfaction (SMD: 0.15; 95% CI: 0.00 to 0.29) and caregiver burden (SMD: -0.13; 95% CI: -0.26 to 0.00). Certainty of evidence was low for all outcomes.

Conclusions: No firm conclusions can be reached about the effects of goal-oriented care for multimorbid adults. Future research should overcome the shortcomings of trials assessed in this meta-analysis. Sound application of the indications for research of complex healthcare interventions is warranted.

Keywords: chronic illness; meta-analysis; multimorbidity; primary care; randomized controlled trials.

Publication types

Meta-Analysis
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Goals
Hospitalization
Humans
Multimorbidity*
Patient Satisfaction
Quality of Life*