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Influences on care preferences of older people with advanced illness: A systematic review and thematic synthesis.

Research output: Contribution to journalLiterature review

Original languageEnglish
JournalJournal of the American Geriatrics Society
StateE-pub ahead of print - 6 Mar 2018

King's Authors


OBJECTIVES: To determine and explore the influences
on care preferences of older people with advanced illness
and integrate our results into a model to guide practice
and research.
DESIGN: Systematic review using Medline, Embase, PsychINFO,
Web of Science, and OpenGrey databases from
inception to February 2017 and reference and citation list
searching. Included articles investigated influences on care
preference using qualitative or quantitative methodology.
Thematic synthesis of qualitative articles and narrative
synthesis of quantitative articles were undertaken.
SETTING: Hospital and community care settings.
PARTICIPANTS: Older adults with advanced illness,
including people with specific illnesses and markers of
advanced disease, populations identified as in the last year
of life, or individuals receiving palliative care
(N = 15,164).
MEASUREMENTS: The QualSys criteria were used to
assess study quality.
RESULTS: Of 12,142 search results, 57 articles were
included. Family and care context, illness, and individual
factors interact to influence care preferences. Support from
and burden on family and loved ones were prominent
influences on care preferences. Mechanisms by which preferences
are influenced include the process of trading-off
between competing priorities, making choices based on
expected outcome, level of engagement, and individual
ability to form and express preferences.
CONCLUSION: Family is particularly important as an
influence on care preferences, which are influenced by
complex interaction of family, individual, and illness factors.
To support preferences, clinicians should consider
older people with illnesses and their families together as a
unit of care.

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