• Carl R May, Amanda Cummings, Michelle Myall, Jonathan Harvey, Catherine Pope, Peter Griffiths, Paul Roderick, Mick Arber, Kasey Boehmer, Frances S Mair, and Alison Richardson.
• Faculty of Health Sciences, University of Southampton, Southampton, UK NIHR CLAHRC Wessex, University of Southampton, Southampton, UK University Hospital Southampton NHS Foundation Trust, Southampton, UK.
• BMJ Open. 2016 Oct 5; 6 (10): e011694.

ObjectivesTo summarise and synthesise published qualitative studies to characterise factors that shape patient and caregiver experiences of chronic heart failure (CHF), chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD).DesignMeta-review of qualitative systematic reviews and metasyntheses. Papers analysed using content analysis.Data SourcesCINAHL, EMBASE, MEDLINE, PsychINFO, Scopus and Web of Science were searched from January 2000 to April 2015.Eligibility Criteria For Selecting StudiesSystematic reviews and qualitative metasyntheses where the participants were patients, caregivers and which described experiences of care for CHF, COPD and CKD in primary and secondary care who were aged ≥18 years.ResultsSearches identified 5420 articles, 53 of which met inclusion criteria. Reviews showed that patients' and caregivers' help seeking and decision-making were shaped by their degree of structural advantage (socioeconomic status, spatial location, health service quality); their degree of interactional advantage (cognitive advantage, affective state and interaction quality) and their degree of structural resilience (adaptation to adversity, competence in managing care and caregiver response to demands).ConclusionsTo the best of our knowledge, this is the first synthesis of qualitative systematic reviews in the field. An important outcome of this overview is an emphasis on what patients and caregivers value and on attributes of healthcare systems, relationships and practices that affect the distressing effects and consequences of pathophysiological deterioration in CHF, COPD and CKD. Interventions that seek to empower individual patients may have limited effectiveness for those who are most affected by the combined weight of structural, relational and practical disadvantage identified in this overview. We identify potential targets for interventions that could address these disadvantages.Systematic Review Registration NumberPROSPERO CRD42014014547.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

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