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  • Primary care physicians’ decision-making processes in the context of multimorbidity: protocol of a systematic review and thematic synthesis of qualitative research

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Qualitative research
Protocol
Primary care physicians’ decision-making processes in the context of multimorbidity: protocol of a systematic review and thematic synthesis of qualitative research
  1. David Silvério Rodrigues1,
  2. Paulo Faria Sousa1,
  3. Nuno Basílio1,
  4. Ana Antunes2,
  5. Maria da Luz Antunes3,
  6. Maria Isabel Santos1,
  7. Bruno Heleno1
  1. 1 Family Medicine Unit, Nova Medical School, Nova University of Lisbon, Lisboa, Portugal
  2. 2 Nova Medical School, Nova University of Lisbon, Chronic Diseases Research Center (CEDOC), Lisboa, Portugal
  3. 3 Instituto Politecnico de Lisboa, Escola Superior de Tecnologia da Saude de Lisboa, Lisboa, Portugal
  1. Correspondence to Dr David Silvério Rodrigues; david.rodrigues{at}nms.unl.pt

Abstract

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.

  • decision making
  • multimorbidity
  • qualitative research
  • primary care

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2018-023832

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    Footnotes

    • Contributors DSR is the guarantor. DSR conceived the review and led the drafting of the protocol. BH and MIS assisted with framing the research question and objectives and contributed to the drafting and revision of the protocol. PFS and NB contributed to the drafting and revision of the protocol. AA assisted with planning the methodological approach and contributed to the drafting and revision of the protocol. MdLA assisted with the search strategy and contributed to the drafting and revision of the protocol. All authors read and approved the final manuscript.

    • Funding This systematic review is supported by the authors and no funding was attributed. This work is part of DSR’s PhD program. Self-funded by the authors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Not required.