Attitudes of multimorbid patients to surviving future acute illness and subsequent functional disability: A systematic review

BACKGROUND Multimorbid patients have worse outcomes following acute hospitalisation. These include increased mortality as an in-patient and after hospital discharge, and increased morbidity and dependence requiring greater use of care facilities. The literature is unclear on the views and wishes of multimorbid patients regarding the outcomes of acute hospitalisation, specifically regarding survival with additional functional disability following acute illness. This is increasingly relevant, with the recent National Institute for Health and Care Excellence (NICE) guidance on admission to hospital and critical care being based on the presence of comorbidities and function as opposed to numerical age. Objectives We performed a systematic review to assess the current qualitative literature exploring attitudes, wishes and perspectives of adult patients with multimorbidity on surviving future acute illness and subsequent acquired functional disability. Eligibility criteria Eligible studies addressed the attitudes, wishes and perspectives of multimorbid adults to illness and treatment-acquired disability using qualitative methods. Information sources: A search of PubMed, Embase, and CINAHL databases was conducted from database inception through April 2020. References lists from selected papers and NICE Guidelines on Multimorbidity (NG56) were searched iteratively for additional relevant articles. Review methods Two researchers reviewed candidate full texts independently. Relevant data was extracted to an evidence table. The risk of bias was avoided by adhering to the previously published extensive search strategy and use of qualitative methodology. RESULTS From 35606 records of which 6370 were duplicates, 20 full texts were reviewed for inclusion, but none met the eligibility criteria. Coverage of domains of importance to multimorbid adults and those highlighted in the NICE guidelines on multimorbidity (NG56) by the 20 short-listed papers was determined; no publications were found to address all domains. DISCUSSION No studies were identified which have applied appropriate qualitative methodology to understand the wishes, attitudes, and preferences of multimorbid adults regarding treatment and outcomes of acute illness. Such enquiries need to be urgently undertaken to inform and progress policy and clinical practice relating to decisions around admission to hospital and critical care. Funding National Institute of Health Research (NIHR) Research for Patient Benefit grant; NIHR Programme grant; NIHR Doctoral Research Fellowship. Registration PROSPERO International Prospective Register of systematic reviews (CRD: 42019155028) ### Competing Interest Statement All authors have completed the ICMJE uniform disclosure form at [www.icmje.org/coi_disclosure.pdf][1] and declare: no support from any organisation for the submitted work; ASM has received non-financial support from Vitaflo ZAP has received honoraria from GlaxoSmithKline, Lyric Pharmaceuticals, Faraday Pharmaceuticals and Fresenius-Kabi; has been paid for developing and delivering educational presentations for Orion and Nestle; and has received non-financial support from Vitaflo. JP has received consultancy fees from Medibeacon Inc, Quark Pharmaceuticals Inc and Nikkiso Europe GmbH and speakers fees and/or hospitality from Baxter Inc, Nikksio Europe GmbH and Fresenius Medical Care AG. JP is an associate editor of the Clinical Kidney journal and Blood Purification, and is on the editorial board of reviewers for Intensive Care Medicine RMP has held research grants, has delivered educational presentations and/or performed consultancy work for Intersurgical, GlaxoSmithKline and Edwards Lifesciences, and holds editorial roles with the British Journal of Anaesthesia, the British Journal of Surgery and BMJ Quality and Safety; no other relationships or activities that could appear to have influenced the submitted work. LF, TJS, AJF have nothing to disclose. ### Clinical Protocols ### Funding Statement ASM and ZP were supported by a National Institute of Health Research (NIHR) Research for Patient Benefit grant (PB-PG-0317-20006); AF was supported by an NIHR Doctoral Research Fellowship (DRF-2018-11-ST2-062); TS was supported an NIHR Programme grant (RP-PG-0218-20001). These researchers are independent from the funders. All authors had full access to all data in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. Role of the funding source: None of these funders had any role in the study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Systematic review so no ethical approval required. All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data can be obtained from the corresponding author. [1]: http://www.icmje.org/coi_disclosure.pdf