Systematic review and meta-analysis on the prevalence and determinants of decision regret in older people with chronic diseases

Introduction
Treatment decision regret (DR) in chronic disease is linked to suboptimal adherence and poor health outcomes. However, evidence for older people remains fragmented across diseases and lacks consistent synthesis of determinants. This study aimed to estimate the pooled prevalence of DR and identify factors associated with regret in this population.

Method
Seven English and four Chinese databases were searched from inception to August 2025. Two researchers independently screened studies reporting the prevalence or determinants of DR among older people with chronic diseases. Study quality was assessed using the Newcastle-Ottawa Scale for cohort studies and AHRQ criteria for cross-sectional studies. Analyses were performed in R (v4.2.2) using both fixed-effect and random-effects models.

Results
Twenty-nine studies involving 30,181 patients were included. The pooled prevalence of DR was 24.8% (25 studies, 95% CI: 18.3%-31.8%, P < 0.0001, I² = 99.7%). Twelve candidate determinants were evaluated across sociodemographic, clinical, functional, psychological, and decisional domains. Significant predictors of higher DR included post-treatment urinary incontinence (10 studies, OR 2.00, 95% CI 1.21-3.29, P < 0.0001, I² = 97.6%) and treatment information insufficiency (3 studies, OR 1.09, 95% CI 1.03-1.16, P < 0.0001, I² = 19.4%). A longer interval since treatment showed a marginal association with increased DR (7 studies, OR 1.01, 95% CI 1.00–1.02, P = 0.9679, I² = 0.0%). No significant associations were found for age, race, employment status, treatment complications, post-treatment physical functions, depression, anxiety, or participation in decision-making.

Conclusions
One in four older people experiences DR following chronic disease treatment decisions. To mitigate regret, clinical practice should focus on managing symptom burden and enhancing decision support through proactive monitoring, adequate patient education, and the use of decision aids to strengthen shared decision-making in geriatric care.