Shared decision-making in patients with multimorbidity from the perspective of general practice

With the continuous increase in life expectancy and changes in lifestyle-related risk factors, multimorbidity has become a global public health challenge and is closely associated with a series of adverse health outcomes, including premature death, functional disability, prolonged hospitalization, and escalating healthcare costs. Patients with multimorbidity often present with complex clinical conditions and significant individual differences. The traditional specialty-oriented, single-disease-centered medical models frequently face limitations like fragmented diagnosis and treatment, conflicting treatment recommendations, overmedicalization, and lack of continuity in care. Thus, effective management of patients with multimorbidity requires moving beyond a single-disease view, integrating individual disease treatment with overall health maintenance, and carefully balancing limited medical resources against the diverse individual needs of patients. Shared decision-making (SDM), as a core patient-centered practice, facilitates the development of personalized care plans by integrating medical evidence with patient ' s preferences, demonstrating significant advantages in improving communication quality, treatment adherence, and patient satisfaction. General practice, characterized by continuity and holistic care and is based on the concept of "whole-person health", provides an ideal framework for SDM in patients with multimorbidity through strategies such as multidisciplinary collaboration and the establishment of long-term. General practitioners, acting as coordinators, information providers, and supporters, can effectively address issues such as information asymmetry and varying degrees of patient engagement during decision-making process. This article systematically reviews the challenges with implementing SDM in patients with multimorbidity, including time constraints, power imbalances, and the influence of social environment. It also summarizes strategies in general practice-based strategies for integrating care pathways and applying decision support tools, and proposes the need for future exploration of practical SDM models and the development of context-specific tools for different medical scenarios in the future. The aim is to offer theoretical foundations and practical guidance for constructing a more efficient and patient-centered multimorbidity management system.