Simon Noah Etkind, Rosanna Fennessy, James Wang, Rhian M Simpson, Bernadette O'Neill, Stephen I G Barclay, Anna Spathis
{"title":"沟通预后不确定性在晚期多重疾病：多方法定性研究共同设计实践建议。","authors":"Simon Noah Etkind, Rosanna Fennessy, James Wang, Rhian M Simpson, Bernadette O'Neill, Stephen I G Barclay, Anna Spathis","doi":"10.1007/s41999-025-01228-6","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Older adults with advanced multimorbidity face an uncertain future due to their unpredictable illness trajectory. Communication of such uncertainty is a core task in healthcare, but there is a limited evidence base to support communication of prognostic uncertainty in multimorbidity. We aimed to co-design clinical practice recommendations for communication of prognostic uncertainty in advanced multimorbidity, based on the lived experience and expertise of patients, carers, and healthcare professionals.</p><p><strong>Methods: </strong>Multi-method qualitative co-design study. In phase one, older adults with advanced multimorbidity, their informal carers, and health professionals participated in interviews and focus groups exploring experiences of uncertainty communication. Transcripts were analysed thematically. In phase two, attendees at two stakeholder events provided feedback on the findings and iteratively developed practice recommendations.</p><p><strong>Results: </strong>Fifteen older adults (median age 80, range 70-89), three informal carers, and 17 health professionals provided qualitative data. We then held workshops with 56 stakeholders. Participants considered that a personalised approach supported discussions of prognostic uncertainty; trusting care relationships, and regard for timing and preparation of all parties were needed. Participants agreed that discussions of uncertainty should proceed based on open and honest discussion within negotiated limits. Clinicians should signpost support and undertake parallel planning for the range of future possibilities to outline the boundaries of uncertainty.</p><p><strong>Conclusion: </strong>This study has developed recommendations for communication of prognostic uncertainty in older people with advanced multimorbidity, to support parallel planning for an unpredictable future. Implementing these recommendations, it may reduce negative impacts of uncertainty and improve care experience.</p>","PeriodicalId":49287,"journal":{"name":"European Geriatric Medicine","volume":" ","pages":"1217-1229"},"PeriodicalIF":3.6000,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12378655/pdf/","citationCount":"0","resultStr":"{\"title\":\"Communicating prognostic uncertainties in advanced multimorbidity: a multimethod qualitative study to co-design practice recommendations.\",\"authors\":\"Simon Noah Etkind, Rosanna Fennessy, James Wang, Rhian M Simpson, Bernadette O'Neill, Stephen I G Barclay, Anna Spathis\",\"doi\":\"10.1007/s41999-025-01228-6\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Older adults with advanced multimorbidity face an uncertain future due to their unpredictable illness trajectory. Communication of such uncertainty is a core task in healthcare, but there is a limited evidence base to support communication of prognostic uncertainty in multimorbidity. We aimed to co-design clinical practice recommendations for communication of prognostic uncertainty in advanced multimorbidity, based on the lived experience and expertise of patients, carers, and healthcare professionals.</p><p><strong>Methods: </strong>Multi-method qualitative co-design study. In phase one, older adults with advanced multimorbidity, their informal carers, and health professionals participated in interviews and focus groups exploring experiences of uncertainty communication. Transcripts were analysed thematically. In phase two, attendees at two stakeholder events provided feedback on the findings and iteratively developed practice recommendations.</p><p><strong>Results: </strong>Fifteen older adults (median age 80, range 70-89), three informal carers, and 17 health professionals provided qualitative data. We then held workshops with 56 stakeholders. Participants considered that a personalised approach supported discussions of prognostic uncertainty; trusting care relationships, and regard for timing and preparation of all parties were needed. Participants agreed that discussions of uncertainty should proceed based on open and honest discussion within negotiated limits. Clinicians should signpost support and undertake parallel planning for the range of future possibilities to outline the boundaries of uncertainty.</p><p><strong>Conclusion: </strong>This study has developed recommendations for communication of prognostic uncertainty in older people with advanced multimorbidity, to support parallel planning for an unpredictable future. Implementing these recommendations, it may reduce negative impacts of uncertainty and improve care experience.</p>\",\"PeriodicalId\":49287,\"journal\":{\"name\":\"European Geriatric Medicine\",\"volume\":\" \",\"pages\":\"1217-1229\"},\"PeriodicalIF\":3.6000,\"publicationDate\":\"2025-08-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12378655/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European Geriatric Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s41999-025-01228-6\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/5/24 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"GERIATRICS & GERONTOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Geriatric Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s41999-025-01228-6","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/5/24 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"GERIATRICS & GERONTOLOGY","Score":null,"Total":0}
Communicating prognostic uncertainties in advanced multimorbidity: a multimethod qualitative study to co-design practice recommendations.
Purpose: Older adults with advanced multimorbidity face an uncertain future due to their unpredictable illness trajectory. Communication of such uncertainty is a core task in healthcare, but there is a limited evidence base to support communication of prognostic uncertainty in multimorbidity. We aimed to co-design clinical practice recommendations for communication of prognostic uncertainty in advanced multimorbidity, based on the lived experience and expertise of patients, carers, and healthcare professionals.
Methods: Multi-method qualitative co-design study. In phase one, older adults with advanced multimorbidity, their informal carers, and health professionals participated in interviews and focus groups exploring experiences of uncertainty communication. Transcripts were analysed thematically. In phase two, attendees at two stakeholder events provided feedback on the findings and iteratively developed practice recommendations.
Results: Fifteen older adults (median age 80, range 70-89), three informal carers, and 17 health professionals provided qualitative data. We then held workshops with 56 stakeholders. Participants considered that a personalised approach supported discussions of prognostic uncertainty; trusting care relationships, and regard for timing and preparation of all parties were needed. Participants agreed that discussions of uncertainty should proceed based on open and honest discussion within negotiated limits. Clinicians should signpost support and undertake parallel planning for the range of future possibilities to outline the boundaries of uncertainty.
Conclusion: This study has developed recommendations for communication of prognostic uncertainty in older people with advanced multimorbidity, to support parallel planning for an unpredictable future. Implementing these recommendations, it may reduce negative impacts of uncertainty and improve care experience.
期刊介绍：
European Geriatric Medicine is the official journal of the European Geriatric Medicine Society (EUGMS). Launched in 2010, this journal aims to publish the highest quality material, both scientific and clinical, on all aspects of Geriatric Medicine.
The EUGMS is interested in the promotion of Geriatric Medicine in any setting (acute or subacute care, rehabilitation, nursing homes, primary care, fall clinics, ambulatory assessment, dementia clinics..), and also in functionality in old age, comprehensive geriatric assessment, geriatric syndromes, geriatric education, old age psychiatry, models of geriatric care in health services, and quality assurance.
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