A systematic review of shared decision-making interventions to improve self-care in multimorbidity: Effects on patient-level and care delivery outcomes

Objectives: Patients with multimorbidity experience unique self-care challenges as they manage multiple conditions simultaneously. Shared decision making is a potentially effective strategy to address these difficulties. However, systematic evidence for this population is limited. The purpose of this systematic review is to describe the components of shared decision-making interventions aimed at improving self-care for patients with multimorbidity and to synthesize evidence of intervention effectiveness related to patient-level and care delivery outcomes. Methods: A systematic literature search was performed in MEDLINE, EMBASE, Cochrane Library, CINAHL, PsycINFO, and trial registries. Experimental studies were included if they examined shared decision-making interventions aimed at improving self-care in adults with two or more chronic diseases. Patient-level outcomes were grouped into three categories: affective-cognitive, behavioral, and health. Methodological quality was evaluated with the Mixed Methods Appraisal Tool. Results: Among the initial 28,865 articles, six studies were included, with overall moderate methodological quality. Interventions mostly consisted of clinician preparation and implementation of a shared decision-making process before, during, and after a clinical encounter. No studies assessed affective-cognitive outcomes. Across the studies, interventions showed limited or inconsistent effects on behavioral and health outcomes. Effects on care delivery outcomes were also mixed, with patient-perceived shared decision making showing no improvement. Conclusions: Evidence on shared decision-making interventions aimed at improving self-care in the context of multimorbidity remains limited, with existing interventions showing inconsistent or limited effects on both patient-level and care delivery outcomes. Practice implications: A meaningful translation of shared decision making into multimorbidity care requires providing clinicians with practical, multimorbidity-specific deliberation support and strengthening patients’ participation. Structured follow-up to revisit care plans and enhance patient activation is also needed to bridge the gap between care planning and behavior change.