Communication Processes Related to Decision-Making in Medication Management Between Healthcare Providers, Older People and Their Carers: A Systematic Review

Abstract

Objective

To examine decision-making between healthcare providers (HCPs), older people and their carers in relation to medication management.

Methods

Four databases were systematically searched up to June 2023. Two authors screened the search results. Extracted quantitative data were analysed descriptively, and qualitative data were analysed thematically.

Results

Fifty-three papers reporting on 49 studies were included. A variety of research methods were utilised. Few authors provided a definition of shared decision-making (SDM). Three major themes were identified: provider-driven decision-making, patient-driven decision-making and a shared role in decision-making. Some older people preferred or deferred to provider-driven decision-making, mainly due to trust in the HCP's expertise. Other reasons for provider-driven decision-making were patient anxiety, declining health, lack of medical knowledge or poor communication during the clinical encounter. Evidence of patient-driven decision-making was often prompted by concerns about the adverse effects of medication. Most older people preferred or adopted a shared role in decision-making.

Conclusion

Whilst most patients and carers preferred to engage in SDM related to medication management, at times, they felt unable to do so, deferring to provider-driven decision-making. There is a need for a standardised definition and measurement of SDM.

Patient or Public Contribution

This systematic review did not directly involve older people or carers of older people in the design or conduct of the review. However, the findings will inform a qualitative study aimed at exploring older people and their carers' experiences of medication-related decision-making in collaboration with their healthcare provider.

Trial Registration: CRD42019124862.