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Can acutely ill patients predict their outcomes? A scoping review
  1. Elisabeth Margaretha Mols1,2,
  2. Harm Haak2,3,
  3. Mark Holland4,5,
  4. Bo Schouten6,7,
  5. Stine Ibsen8,9,
  6. Hanneke Merten10,11,
  7. Erika Frischknecht Christensen8,
  8. Prabath W B Nanayakkara12,
  9. Christian Hans Nickel13,
  10. Immo Weichert14,
  11. John Kellett15,
  12. Christian Peter Subbe16,17,
  13. Marjolein N T Kremers1
  14. Safer@Home Research Consortium
    1. 1Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Aging and Long Term Care, Maastricht University, Maastricht, The Netherlands
    2. 2Internal Medicine, Maxima Medical Centre Location Veldhoven, Veldhoven, The Netherlands
    3. 3Department of Health Services Research and CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
    4. 4Department of Clinical and Biomedical Sciences, University of Bolton, Bolton, UK
    5. 5Department of Internal Medicine, Salford Royal NHS Foundation Trust, Salford, UK
    6. 6Department of Public and Occupational Health, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
    7. 7Maastricht University Care and Public Health Research Institute, Maastricht, The Netherlands
    8. 8Center for Prehospital and Emergency Research, Clinic of Internal and Emergency Medicine, Aalborg Universitetshospital, Aalborg, Denmark
    9. 9Physiotherapy, Aalborg University, Aalborg, Denmark
    10. 10Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
    11. 11Acute Care Network North-West, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
    12. 12Section of Acute Medicine, Department of Internal Medicine, Amsterdam Universitair Medische Centra, Amsterdam, The Netherlands
    13. 13Emergency Medicine, University Hospital Basel, Basel, Switzerland
    14. 14Department of Acute Medicine, Ipswich Hospital NHS Trust, Ipswich, UK
    15. 15Emergency Medicine, Sydvestjysk Sygehus, Esbjerg, Denmark
    16. 16Department of Acute Medicine, Ysbyty Gwynedd, Bangor, UK
    17. 17School of Medical Sciences, Bangor University, Bangor, UK
    18. 18Maxima Medical Centre Location Veldhoven, Veldhoven, The Netherlands
    1. Correspondence to Elisabeth Margaretha Mols, Máxima Medical Centre -Internal Medicine, 4600 De Run, 5504 DB, Veldhoven, The Netherlands; elsemieke.mols{at}mmc.nl

    Abstract

    Introduction The full impact of an acute illness on subsequent health is seldom explicitly discussed with patients. Patients’ estimates of their likely prognosis have been explored in chronic care settings and can contribute to the improvement of clinical outcomes and patient satisfaction. This scoping review aimed to identify studies of acutely ill patients’ estimates of their outcomes and potential benefits for their care.

    Methods A search was conducted in PubMed, Embase, Web of Science and Google Scholar, using terms related to prognostication and acute care. After removal of duplicates, all articles were assessed for relevance by six investigator pairs; disagreements were resolved by a third investigator. Risk of bias was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions.

    Results Our search identified 3265 articles, of which 10 were included. The methods of assessing self-prognostication were very heterogeneous. Patients seem to be able to predict their need for hospital admission in certain settings, but not their length of stay. The severity of their symptoms and the burden of their disease are often overestimated or underestimated by patients. Patients with severe health conditions and their relatives tend to be overoptimistic about the likely outcome.

    Conclusion The understanding of acutely ill patients of their likely outcomes and benefits of treatment has not been adequately studied and is a major knowledge gap. Limited published literature suggests patients may be able to predict their need for hospital admission. Illness perception may influence help-seeking behaviour, speed of recovery and subsequent quality of life. Knowledge of patients’ self-prognosis may enhance communication between patients and their physicians, which improves patient-centred care.

    • acute care
    • hospitalisations
    • assessment
    • communication
    • emergency care systems

    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplemental information.

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplemental information.

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    Footnotes

    • Handling editor Mary Dawood

    • Twitter @csubbe

    • Collaborators Collaborator group name: Safer@Home Research Consortium. Individual names: (1) Alsma, Jelmer; (2) Brabrand, Mikkel; (3) Cooksley Tim; (4) Christensen, Erika F.; (5) Haak, Harm R.; (6) Holland, Mark; (7) Ibsen, Stine; (8) Kellett, John; (9) Kremers, Marjolein N.T.; (10) Merten, Hanneke; (11) Mols, Elisabeth M.; (12) Nanayakkara, Prabath W.B.; (13) Nickel, Christian H.; (14) Schouten, Bo; (15) Subbe, Chris P.; (16) Weichtert, Immo.

    • Contributors CPS, CHN and TC conceived the idea for this research. CPS, HH, PWBN, MNTK and HM designed the project. EMM, HM and MNTK were responsible for the search. All authors (EMM, HH, MH, SI, BS, HM, EFC, PWBN, CHN, IW, JK, CPS and MNTK) were responsible for the evaluation and data extraction of the articles. EMM reviewed all the extracted data and made the result tables and figures, and performed the risk-of-bias assessment. EMM drafted the manuscript. All authors (EMM, HH, MH, SI, BS, HM, EFC, PWBN, CHN, IW, JK, CPS and MNTK) critically revised the manuscript for important intellectual content. All authors read and approved the final manuscript. EMM and MNTK act as guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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