‘Adrift in a sea of just absolute unknowableness’ - A multimethod qualitative study exploring patient, carer and healthcare professional experiences of communicating about future uncertainty in multimorbidity

Sep 30, 2026

Uploaded by Liam

Uncertainty about the future is commonly experienced by older adults with advanced multimorbidity, shaping anxiety and multiple life domains. Communication about future uncertainty influences patient satisfaction, decision-making quality, and opportunities for future planning. This multimethod qualitative study used in-depth interviews and focus groups with older adults, nominated carers, and community and inpatient healthcare professionals to examine experiences and preferences for uncertainty communication. Findings highlight acceptance versus avoidance, mismatched preferences, missed timely conversations, and needs for tailored communication training.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Abstract

Background

Aim

Design

Setting/participants

Results

Conclusions

Keywords

What this paper adds

Implications for practice, theory or policy

‘Adrift in a sea of just absolute unknowableness’: A multimethod qualitative study exploring patient, carer and healthcare professional experiences of communicating about future uncertainty in multimorbidity Rosanna Fennessy1, Anna Spathis1,2, Stephen Barclay1 and Simon Noah Etkind1,2 Palliative Medicine 2026, Vol. 40(1) 84–94 © The Author(s) 2025 Article reuse guidelines: [sagepub.com/journals-permissions](sagepub.com/journals-permissions)[ ](sagepub.com/journals-permissions)[DOI: 10.1177/02692163251393586](DOI: 10.1177/02692163251393586)[ ](DOI: 10.1177/02692163251393586)[journals.sagepub.com/home/pmj](journals.sagepub.com/home/pmj) Abstract Background: Uncertainty about the future is commonly experienced by older adults with advanced multimorbidity, impacting multiple life domains and frequently causing anxiety. Communicating about future uncertainty affects patient satisfaction, quality of decision-making and opportunities for future planning. Patient, carer and healthcare professional experiences of future uncertainty communication have been little studied to date. Aim: In the context of older adults with advanced multimorbidity, to explore patient, carer and healthcare professional experiencesand preferences for communication of uncertainty about their future. Design: Multi-method qualitative research utilising in-depth interviews and focus groups with reflexive thematic analysis. Setting/participants: Older adults with advanced multimorbidity (n = 15), their nominated informal carers (n = 3), and community and inpatient healthcare professionals working with this population (n = 17) . Results: Participants’ experiences of uncertainty communication were influenced by their acceptance or avoidance of addressing future unknowns. Patients and their informal carers expressed a range of information needs: they prioritised open and honest dialogue with healthcare professionals, tailored to their unique circumstances and supported by reassurance and proactive plans, even when medical options were limited. Healthcare professionals acknowledged the importance of addressing uncertainty: they expressed a lack of experience and confidence and feared upsetting patients or losing their trust. As a result, opportunities for timely and personalised communications may be missed. Conclusions: To support patients and carers navigate the inherent uncertainties of advanced multimorbidity, healthcare professionals would benefit from tailored communication training designed to increase their experience of undertaking honest and open dialogue about future uncertainties, informed by patients’ individual context and preferences. Keywords uncertainty, communication, multimorbidity, healthcare planning, older adults What is already known about this topic? • Multimorbidity affects increasing numbers of older people worldwide: the complexity of managing multiple illnesses creates future uncertainty for patients, carers and healthcare professionals. • Uncertainty impacts physical, psychological, social and existential domains and is often distressing for patients and carers. • The ways in which healthcare professionals communicate about future uncertainty impacts patient satisfaction and decision-making, including treatment choices. 1Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, UK 2Cambridge University Hospitals NHS Foundation Trust, UK Corresponding author: Rosanna Fennessy, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, East Forvie Building, Cambridge Biomedical Campus, Cambridge CB20SR, UK. Email: [rtf21@medschl.cam.ac.uk](rtf21@medschl.cam.ac.uk) What this paper adds • Patients, carers and healthcare professionals have a mixture of acceptance and avoidance when considering future uncertainty, which influences the way communication is undertaken and experienced. • Mismatches in communication preferences may lead to

FAQs

What does future uncertainty affect for older adults with advanced multimorbidity?

It affects multiple life domains, often causing anxiety, and it can shape satisfaction, decision-making, and future planning opportunities.

How was the study conducted?

It used multi-method qualitative research, including in-depth interviews and focus groups, analyzed with reflexive thematic analysis.

What barriers did healthcare professionals report when communicating uncertainty?

They described limited experience and confidence, along with fears of upsetting patients or losing trust, which could delay or prevent timely personalized communication.

Sep 30, 2026

Uploaded by Liam