Uncertainty in multimorbidity: a shared experience we should recognise, acknowledge and communicate
Multimorbidity is increasingly common and inevitably results in uncertainties about health, care and the future. Such uncertainties may be experienced by patients, carers and health professionals. Given the ubiquitous presence of uncertainty, all professionals should be prepared to approach and address it in clinical practice. Uncertainty in multimorbidity can rarely be eliminated, and so, must be carefully addressed and communicated; however, there is little evidence on how to approach it. Key areas are: recognising the existence of uncertainty, acknowledging it, and communicating to achieve a shared understanding. Evaluation of what has been discussed, and preparedness to repeat such conversations are also important. Future research should explore optimal communication of uncertainty in multimorbidity.
The prevalence of illness increases as people get older, such that over 50% of those over 65 years have multiple chronic conditions or ‘multimorbidity’ (Barnett et al, 2012). Multimorbidity impacts on a person's quality of life and can lead to progressive functional impairment (Ryan et al, 2015). Older adults are increasingly living with multiple serious or life-limiting illnesses and cause-of-death projections indicate this trend will continue (Finucane et al, 2021).
While guidelines recommend co-ordinated, person-centred care in multimorbidity (Farmer et al, 2016), in reality, those with multiple serious illnesses face complex and fragmented care (Zwijsen et al, 2016). They experience an unpredictable illness trajectory, meaning that the course of their future illnesses is unknown and unknowable. Consequently, uncertainty is a particularly prominent experience in multimorbidity (Etkind et al, 2016; Mason et al, 2016). Informal carers of multimorbid older people also experience uncertainty, and this can be unrelenting; some feel overwhelmed by continual uncertainty regarding what will happen next and how they should respond, which can adversely impact their own lives and increase carer burden (Nanton et al, 2015; Price et al, 2019; Andersen et al, 2020).
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