title: Lived experiences of multimorbidity: An interpretative meta-synthesis of patients', general practitioners' and trainees' perceptions.
abstract: OBJECTIVE
  Multimorbidity is an increasing challenge. Better understanding of lived experiences of patients, general practitioners and trainees, may advance patient care and medical education. This interpretative meta-synthesis sought to (i) understand lived experiences of patients, general practitioners and trainees regarding multimorbidity, (ii) identify how similarities and differences in experiences should shape future solutions.
  
  
  METHODS
  Empirical studies containing qualitative data and pertaining to lived experiences from our recent realist synthesis (PROSPERO 2013:CRD42013003862) were included. Following quality assessment, data were extracted from key studies to build an integrated analytic framework. Data from remaining studies were utilised to expand and refine the framework through thematic analysis of concepts within and between perspectives.
  
  
  RESULTS
  Twenty-one papers were included in the meta-synthesis. Analysis of 70 concepts produced five themes: (1) goals of care and decision making, (2) complexity, (3) meeting expectations, (4) logistics and (5) interpersonal dynamics. The complexities of multimorbidity lead to shared feelings of vulnerability, uncertainty and enforced compromises. Barriers to optimal care-education included system constraints, inadequate continuity and role uncertainty.
  
  
  CONCLUSIONS
  There was little evidence of shared discussion of these challenges. Addressing these issues and more explicit exploration of the experiences of each group during interactions may improve delivery and satisfaction in care and education.
authors.affiliation: Keele University, Keele, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Cottrell
authors.affiliation: Keele University, Keele, UK s.yardley@keele.ac.uk.
authors.forename: Sarah
authors.initials: S
authors.lastname: Yardley
mesh_terms: D001291:Attitude of Health Personnel; D001294:Attitude to Health; D002908:Chronic Disease / Q000523:psychology*; D000066491:Clinical Decision-Making; D015897:Comorbidity; D058005:General Practitioners / Q000523:psychology*; D006801:Humans; D010347:Patient Care Planning; D011369:Professional-Patient Relations; D036301:Qualitative Research
keywords: Multimorbidity; general practitioners; lived experiences; patients; trainees