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Meta-Analysis
. 2022 Jun;28(3):371-381.
doi: 10.1111/jep.13674. Epub 2022 Mar 30.

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

Angelo Barbato  1 , Barbara D'Avanzo  1 , Michela Cinquini  2 , Andrea Veronica Fittipaldo  2 , Alessandro Nobili  3 , Laura Amato  4 , Simona Vecchi  4 , Graziano Onder  5
Affiliations
Meta-Analysis

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

Angelo Barbato et al. J Eval Clin Pract. 2022 Jun.

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.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Selection of papers through the review process
Figure 2
Figure 2
Risk of bias assessment
Figure 3
Figure 3
Results of the comparisons of goal‐oriented care and standard treatment
See this image and copyright information in PMC

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