{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:50:13Z","timestamp":1787028613907,"version":"build-2736575974"},"reference-count":55,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2020,12,29]],"date-time":"2020-12-29T00:00:00Z","timestamp":1609200000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"German Federal Ministry of Education and Research","award":["01GL1729"],"award-info":[{"award-number":["01GL1729"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Unpredictable disease trajectories make early clarification of end-of-life (EoL) care preferences in older patients with multimorbidity advisable. This mixed methods systematic review synthesizes studies and assesses such preferences. Two independent reviewers screened title\/abstracts\/full texts in seven databases, extracted data and used the Mixed Methods Appraisal Tool to assess risk of bias (RoB). We synthesized findings from 22 studies (3243 patients) narratively and, where possible, quantitatively. Nineteen studies assessed willingness to receive life-sustaining treatments (LSTs), six, the preferred place of care, and eight, preferences regarding shared decision-making processes. When unspecified, 21% of patients in four studies preferred any LST option. In three studies, fewer patients chose LST when faced with death and deteriorating health, and more when treatment promised life extension. In 13 studies, 67% and 48% of patients respectively were willing to receive cardiopulmonary resuscitation and mechanical ventilation, but willingness decreased with deteriorating health. Further, 52% of patients from three studies wished to die at home. Seven studies showed that unless incapacitated, most patients prefer to decide on their EoL care themselves. High non-response rates meant RoB was high in most studies. Knowledge of EoL care preferences of older patients with multimorbidity increases the chance such care will be provided.<\/jats:p>","DOI":"10.3390\/jcm10010091","type":"journal-article","created":{"date-parts":[[2020,12,29]],"date-time":"2020-12-29T19:55:25Z","timestamp":1609271725000},"page":"91","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":48,"title":["End-of-Life Care Preferences of Older Patients with Multimorbidity: A Mixed Methods Systematic Review"],"prefix":"10.3390","volume":"10","author":[{"given":"Ana I.","family":"Gonz\u00e1lez-Gonz\u00e1lez","sequence":"first","affiliation":[{"name":"Institute of General Practice, Goethe University, 60590 Frankfurt am Main, Germany"},{"name":"Red de Investigaci\u00f3n en Servicios de Salud en Enfermedades Cr\u00f3nicas (REDISSEC), 28035 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1188-3158","authenticated-orcid":false,"given":"Christine","family":"Schmucker","sequence":"additional","affiliation":[{"name":"Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79110 Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Nothacker","sequence":"additional","affiliation":[{"name":"Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79110 Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edris","family":"Nury","sequence":"additional","affiliation":[{"name":"Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79110 Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9774-6751","authenticated-orcid":false,"given":"Truc Sophia","family":"Dinh","sequence":"additional","affiliation":[{"name":"Institute of General Practice, Goethe University, 60590 Frankfurt am Main, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria-Sophie","family":"Brueckle","sequence":"additional","affiliation":[{"name":"Institute of General Practice, Goethe University, 60590 Frankfurt am Main, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeanet W.","family":"Blom","sequence":"additional","affiliation":[{"name":"Department of Public Health and Primary Care, Leiden University Medical Center, 2300 RC Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1022-8637","authenticated-orcid":false,"given":"Marjan","family":"van den Akker","sequence":"additional","affiliation":[{"name":"Institute of General Practice, Goethe University, 60590 Frankfurt am Main, Germany"},{"name":"Department of Family Medicine, School CAPHRI, Maastricht University, 6200 Maastricht, The Netherlands"},{"name":"Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, 3000 Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristian","family":"R\u00f6ttger","sequence":"additional","affiliation":[{"name":"Patient Representative, Federal Joint Committee \u201cGemeinsamer Bundseausschuss\u201d, 10587 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Odette","family":"Wegwarth","sequence":"additional","affiliation":[{"name":"Center for Adaptive Rationality, Max Planck-Institute for Human Development, 14195 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tammy","family":"Hoffmann","sequence":"additional","affiliation":[{"name":"Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD 4226, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ferdinand M.","family":"Gerlach","sequence":"additional","affiliation":[{"name":"Institute of General Practice, Goethe University, 60590 Frankfurt am Main, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon E.","family":"Straus","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1333-5403","authenticated-orcid":false,"given":"Joerg J.","family":"Meerpohl","sequence":"additional","affiliation":[{"name":"Institute for Evidence in Medicine (for Cochrane Germany 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