Health care professionals' experiences and perceptions of making treatment decisions for older adults with memory loss: a qualitative systematic review.

Objective: This systematic review aimed to appraise and synthesize evidence about licensed health care professionals' experiences and perceptions of treatment decision-making affecting older people with memory loss and comorbid conditions.

Introduction: Treatment decision-making affecting older people with memory loss and comorbid conditions presents significant challenges for health care professionals as existing clinical practice guidelines and health care services are designed to focus on managing single-disease conditions. The complexity of balancing comorbid conditions, in addition to memory loss, has led to increased research in this area. Given the growing body of literature exploring health care professionals' decision-making, a synthesis of this evidence is needed to provide clearer insights and inform practice.

Eligibility criteria: This review considered qualitative studies that explored licensed health care professionals' treatment decisions when providing care for older people (over 65 years) living with memory loss and comorbid conditions. We considered studies conducted across community and clinical settings.

Methods: A 3-step search strategy was used in May 2022 to identify published and unpublished studies across the CINAHL (EBSCOhost), MEDLINE (EBSCOhost), PsycINFO (EBSCOhost), Scopus, and ProQuest Dissertations and Theses (ProQuest). Additionally, relevant websites were searched using keywords to identify gray literature. Searches covered all available literature from database inception using a combination of controlled vocabulary (MeSH and CINAHL headings) and keywords to capture qualitative studies, with an updated search conducted in June 2023. Two independent reviewers completed the title/abstract and full-text screening, critical appraisal, data extraction, and data synthesis. Findings classified as unequivocal or credible were grouped into categories that were synthesized to generate a comprehensive set of findings. The ConQual approach was applied to assess confidence in qualitative research synthesis.

Results: Fourteen studies published between 2006 and 2022 met the eligibility criteria. A total of 76 findings were extracted and grouped into 8 categories. Three synthesized findings were assembled from the findings: i) Health care professionals experience uncertainty and perceive older people with memory loss in ways that influence their treatment decision-making; ii) Communication challenges and contextual factors unique to older persons, families, and health service organizations influences health care professionals' treatment decision-making affecting older people with memory loss and comorbid conditions; and iii) health care professionals identify processes to support safeguarding older people with memory loss in treatment decision-making.

Conclusions: Health care professionals' treatment decision-making practices varied across medical specialties, with similarities spanning clinical settings. Health care professionals were committed to ensuring that older patients with memory loss and comorbid conditions received treatment to enhance their quality of life while promoting safe and ethical care. However, they held assumptions about these patients' abilities, viewed communication as challenging, and did not always have a clear understanding of patient preferences. This review identified that health care professionals who care for this population require further education. Changes to health care professionals' treatment decision-making are needed to ensure that older people and their family members are actively engaged in the processes of shared decision-making, which will support a person- and family-centered care approach.

Review registration: PROSPERO CRD42021271485.