OBJECTIVES uncertainty pervades the complex illness trajectories experienced by older adults with multimorbidity. Uncertainty is experienced by older people, their informal carers and professionals providing care, yet is incompletely understood. We aimed to identify and synthesise systematically the experience of uncertainty in advanced multimorbidity from patient, carer and professional perspectives. DESIGN systematic literature review of published and grey qualitative literature from 9 databases (Prospero CRD 42021227480). PARTICIPANTS older people with advanced multimorbidity, and informal carers/professionals providing care to this group. Exclusion criteria: early multimorbidity, insufficient focus on uncertainty. ANALYSIS weight-of-evidence assessment was used to appraise included articles. We undertook thematic synthesis of multi-perspective experiences and response to uncertainty. RESULTS from 4,738 unique search results, we included 44 articles relating to 40 studies. 22 focused on patient experiences of uncertainty (n = 460), 15 on carer experiences (n = 197), and 19 on health professional experiences (n = 490), with 10 exploring multiple perspectives. We identified a shared experience of 'Total Uncertainty' across five domains: 'appraising and managing multiple illnesses'; 'fragmented care and communication'; 'feeling overwhelmed'; 'uncertainty of others' and 'continual change'. Participants responded to uncertainty by either active (addressing, avoiding) or passive (accepting) means. CONCLUSIONS the novel concept of 'Total Uncertainty' represents a step change in our understanding of illness experience in advanced multimorbidity. Patients, carers and health professionals experienced uncertainty in similar domains, suggesting a shared understanding is feasible. The domains of total uncertainty form a useful organising framework for health professionals caring for older adults with multimorbidity.

中文翻译：

---

完全不确定性：对患有晚期多重疾病的老年人、他们的非正式护理人员和卫生专业人员的不确定性经历进行系统审查和主题综合。

目标不确定性遍及患有多种疾病的老年人所经历的复杂疾病轨迹。老年人、他们的非正式护理人员和提供护理的专业人士都经历过不确定性，但人们并不完全了解不确定性。我们的目标是从患者、护理人员和专业人士的角度系统地识别和综合晚期多重病症的不确定性体验。设计来自 9 个数据库的已发表和灰色定性文献的系统文献综述 (Prospero CRD 42021227480)。参与者患有晚期多重疾病的老年人，以及为该群体提供护理的非正式护理人员/专业人员。排除标准：早期多发病，对不确定性关注不足。ANALYSIS 证据权重评估用于评价纳入的文章。我们对多视角经验和对不确定性的反应进行了专题综合。从 4,738 个独特的搜索结果中，我们纳入了与 40 项研究相关的 44 篇文章。22 项关注患者的不确定性体验 (n = 460)，15 项关注护理人员体验 (n = 197)，19 项关注健康专业经验 (n = 490)，其中 10 项探索多个视角。我们在五个领域确定了“完全不确定”的共同经历：“评估和管理多种疾病”；“碎片化的护理和沟通”；'感觉不知所措'; “他人的不确定性”和“持续变化”。参与者通过主动（解决、避免）或被动（接受）方式应对不确定性。结论“完全不确定性”的新概念 代表了我们对晚期多病症疾病经历的理解的一步变化。患者、护理人员和卫生专业人员在类似领域都经历过不确定性，这表明达成共识是可行的。完全不确定的领域为照顾患有多种疾病的老年人的卫生专业人员提供了一个有用的组织框架。