Primary care physicians' decision-making processes in the context of multimorbidity: protocol of a systematic review and thematic synthesis of qualitative research.
David Silvério Rodrigues, Paulo Faria Sousa, Nuno Basílio, Ana Antunes, Maria da Luz Antunes, Maria Isabel Santos, Bruno Heleno
Author Information
David Silvério Rodrigues: Family Medicine Unit, Nova Medical School, Nova University of Lisbon, Lisboa, Portugal. ORCID
Paulo Faria Sousa: Family Medicine Unit, Nova Medical School, Nova University of Lisbon, Lisboa, Portugal.
Nuno Basílio: Family Medicine Unit, Nova Medical School, Nova University of Lisbon, Lisboa, Portugal.
Ana Antunes: Nova Medical School, Nova University of Lisbon, Chronic Diseases Research Center (CEDOC), Lisboa, Portugal. ORCID
Maria da Luz Antunes: Instituto Politecnico de Lisboa, Escola Superior de Tecnologia da Saude de Lisboa, Lisboa, Portugal.
Maria Isabel Santos: Family Medicine Unit, Nova Medical School, Nova University of Lisbon, Lisboa, Portugal.
Bruno Heleno: Family Medicine Unit, Nova Medical School, Nova University of Lisbon, Lisboa, Portugal.
INTRODUCTION: Good patient outcomes correlate with the physicians' capacity for good clinical judgement. Multimorbidity is common and it increases uncertainty and complexity in the clinical encounter. However, healthcare systems and medical education are centred on individual diseases. In consequence, recognition of the patient as the centre of the decision-making process becomes even more difficult. Research in clinical reasoning and medical decision in a real-world context is needed. The aim of the present review is to identify and synthesise available qualitative evidence on primary care physicians' perspectives, views or experiences on decision-making with patients with multimorbidity. METHODS AND ANALYSIS: This will be a systematic review of qualitative research where PubMed, CINAHL, PsycINFO, Embase and Web of Science will be searched, supplemented with manual searches of reference lists of included studies. Qualitative studies published in Portuguese, Spanish and English language will be included, with no date limit. Studies will be eligible when they evaluate family physicians' perspectives, opinions or perceptions on decision-making for patients with multimorbidity in primary care. The methodological quality of studies selected for retrieval will be assessed by two independent reviewers before inclusion in the review using the Critical Appraisal Skills Programme (CASP) tool. Thematic synthesis will be used to identify key categories and themes from the qualitative data. The Confidence in the Evidence from Reviews of Qualitative research approach will be used to assess how much confidence to place in findings from the qualitative evidence synthesis. ETHICS AND DISSEMINATION: This review will use published data. No ethical issues are foreseen. The findings will be disseminated to the medical community via journal publication and conference presentation(s). PROSPERO REGISTRATION NUMBER: ID 91978.
