Definitions of advanced multimorbidity : a scoping review

Abstract

Background Increasing numbers of people are living with and dying from multimorbidity (the presence of two or more physical or mental health conditions). However, it has been seen as challenging to identify when people with multiple health conditions may be approaching the end of life (so-called advanced multimorbidity). Aims & Objectives This scoping review aims to comprehensively detail how advanced multimorbidity are currently defined in research, policy and clinical practice. Methods This scoping review is reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). A search strategy was developed and implemented into Medline, EMBASE, CINAHL, Scopus and PsychINFO. A further grey literature search was undertaken. Title and abstract then full text screening was undertaken by three co-reviewers. The study’s Public Advisory Group have been instrumental in shaping the research question and summarising our findings. Results From 13,758 initial studies  9499 titles and abstracts screened  760 full texts screened  approximately 50 full texts included. There were no studies found from low-middle income countries. Various study designs were utilised, most were retrospective observational studies. Definitions of advanced multimorbidity were often study-specific however a few used a validated prognostic tool e.g. NECPAL. Very few end-of-life care policies were specific to people with advanced multimorbidity. Conclusion The results of this scoping review will enable researchers, policy makers, clinicians and patients to better understand ways to identify when people with multimorbidity may be approaching the end of life.