EFFECTS OF GOAL ORIENTED CARE FOR ADULTS WITH MULTIMORBIDITY. A
SYSTEMATIC REVIEW AND META-ANALYSIS
Objective. To systematically review the evidence from randomised
controlled trials evaluating the effects of goal oriented care against
standard care for multimorbid adults. Data sources/Study setting.
Existing literature presenting the resulto of randomized trials
assessing the outcome 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
Organizational International Clinical Trials Registry Platform (ICTRP)
and the references of eligible trials and relevant reviews.
Goal-oriented care was defined by the following: goal setting at the
individual level; collaborative identification of goals; valuing and
using the individuals’ resources and skills combined with the medical
standpoint; full entitlement of the person in the goal choice. A total
of 197 studies were reviewed. Ten trials 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 found fully free of bias. No effect was found on
quality of life (Standardized Mean Difference (SMD) 0.10; 95% CI -0.06
to 0.26) and hospital admission (Risk Ratio (RR): 0.87; 95% CI 0.65 to
1.17). A very small effect was observed 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 Despite its sound rationale and the strong push towards its
dissemination, the results of this meta-analysis prevent to reach firm
conclusions about effects of goal-oriented care. Future research should
overcome the shortcomings of studies assessed in this meta-analysis. A
sound application of the indications for research of complex healthcare
interventions is warranted.