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Hjelm M, Andersson A, Ujkani V, Andersson EK. Registered nurse case managers' work experiences with a person-centered collaborative healthcare model: an interview study. BMC Health Serv Res 2024; 24:1108. [PMID: 39313787 PMCID: PMC11421112 DOI: 10.1186/s12913-024-11500-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 08/28/2024] [Indexed: 09/25/2024] Open
Abstract
BACKGROUND Multimorbidity is increasingly acknowledged as a significant health concern, particularly among older individuals. It is associated with a decline in quality of life and psychosocial well-being as well as an increased risk of being referred to multiple healthcare providers, including more frequent admissions to emergency departments. Person-centered care interventions tailored to individuals with multimorbidity have shown promising results in improving patient outcomes. Research is needed to explore how work practices within integrated care models are experienced from Registered Nurse Case Managers' (RNCMs) perspective to identify areas of improvement. Therefore, the aim of this study was to describe RNCMs' work experience with a person-centered collaborative healthcare model (PCCHCM). METHODS This study used an inductive design. The data were collected through individual interviews with 11 RNCMs and analyzed using qualitative content analysis. RESULTS Data analysis resulted in four generic categories: 'Being a detective, 'Being a mediator', 'Being a partner', and 'Being a facilitator of development' which formed the basis of the main category 'Tailoring healthcare, and social services to safeguard the patient's best.' The findings showed that RNCMs strive to investigate, identify, and assess older persons' needs for coordinated care. They worked closely with patients and their relatives to engage them in informed decision-making and to implement those decisions in a personalized agreement that served as the foundation for the care and social services provided. Additionally, the RNCMs acted as facilitators of the development of the PCCHCM, improving collaboration with other healthcare professionals and enhancing the possibility of securing the best care for the patient. CONCLUSIONS The results of this study demonstrated that RNCMs tailor healthcare and social services to provide care in various situations, adhering to person-centered care principles and continuity of care. The findings underline the importance of implementing integrated care models that consider the unique characteristics of each care context and adapt different case managers' roles based on the patient's individual needs as well as on the specific needs of the local setting. More research is needed from the patients' and their relatives' perspectives to deepen the understanding of the PCCHCM concerning its ability to provide involvement, security, and coordination of care.
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Affiliation(s)
- Markus Hjelm
- Blekinge Centre of Competence, Region Blekinge, Karlskrona, Sweden.
- Department of Clinical Sciences in Malmö, Lund University, Lund, Sweden.
| | - Anna Andersson
- Blekinge Centre of Competence, Region Blekinge, Karlskrona, Sweden
| | - Venera Ujkani
- Blekinge Centre of Competence, Region Blekinge, Karlskrona, Sweden
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Gray L, Bullock L, Chew-Graham CA, Jinks C, Paskins Z, Hider S. Reviews for multimorbidity risk in people with inflammatory conditions: a qualitative study. BJGP Open 2024:BJGPO.2024.0011. [PMID: 38580391 DOI: 10.3399/bjgpo.2024.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/18/2024] [Accepted: 03/25/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND People with inflammatory rheumatological conditions (IRCs) are at high risk of developing other conditions including cardiovascular disease (CVD) and mood disorders. AIM To explore perspectives of people with IRCs and healthcare practitioners (HCPs) on the content and delivery of a review consultation aimed at identification and management of multiple long-term conditions (mLTCs). DESIGN & SETTING Semi-structured interviews and focus groups with people with IRCs and HCPs in primary and secondary care. METHOD People with IRCs participated in individual semi-structured interviews by telephone or online platform. HCPs (including primary and secondary care clinicians) participated in online focus groups. Data were transcribed verbatim and analysed using inductive thematic analysis. RESULTS Fifteen people with IRCs were interviewed; three focus groups with HCPs were conducted. The following two main themes were identified: reflecting on the value of review consultations; and what would a new review look like? Overall, people with IRCs and HCPs reflected that access to reviews is inequitable, leading to duplication of reviews and fragmentation in care. People with IRCs, at times, had difficulty conceptualising reviews, especially when discussing their future risk of conditions. People suggested that preparation before the healthcare review could align patient and HCP agendas as part of a flexible and person-centred discussion. CONCLUSION Any review introduced for people with IRCs must move beyond a 'tick-box' exercise. To gain maximum value from a review, preparation from both patient and HCP may be required alongside a person-centred approach while ensuring they are targeted at people most likely to benefit.
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Affiliation(s)
- Lauren Gray
- Haywood Academic Rheumatology Centre, Midlands Partnership University Foundation Trust, Stoke-on-Trent, UK
- School of Medicine, Keele University, Keele, UK
| | | | | | - Clare Jinks
- School of Medicine, Keele University, Keele, UK
| | - Zoe Paskins
- Haywood Academic Rheumatology Centre, Midlands Partnership University Foundation Trust, Stoke-on-Trent, UK
- School of Medicine, Keele University, Keele, UK
| | - Samantha Hider
- Haywood Academic Rheumatology Centre, Midlands Partnership University Foundation Trust, Stoke-on-Trent, UK
- School of Medicine, Keele University, Keele, UK
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Kvestad CA, Holte IR, Reitan SK, Chiappa CS, Helle GK, Skjervold AE, Rosenlund AMA, Watne Ø, Brattland H, Helle J, Follestad T, Hara KW, Holgersen KH. Measuring the Effect of the Early assessment Team (MEET) for patients referred to outpatient mental health care: a study protocol for a randomised controlled trial. Trials 2024; 25:179. [PMID: 38468321 DOI: 10.1186/s13063-024-08028-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 03/01/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Referrals to specialised mental health care (such as community mental health centres; CMHC) have increased over the last two decades. Patients often have multifaceted problems, which cannot only be solved by such care. Resources are limited, and triaging is challenging. A novel method which approaches patients early and individually upon referral to a CMHC-possibly with a brief intervention-is an Early assessment Team (EaT). In an EaT, two therapists meet the patient early in the process and seek to solve the present problem, often involving community services, primary health care, etc.; attention is paid to symptoms and functional strife, rather than diagnoses. This is in contrast to treatment as usual (TAU), where the patient (after being on a waiting list) meets one therapist, who focuses on history and situation to assign a diagnosis and eventually start a longitudinal treatment. The aim of this study is to describe and compare EaT and TAU regarding such outcomes as work and social adjustment, mental health, quality of life, use of health services, and patient satisfaction. The primary outcome is a change in perceived function from baseline to 12-month follow-up, measured by the Work and Social Adjustment Scale. METHOD Patients (18 years and above; n = 588) referred to outpatient health care at a CMHC are randomised to EaT or TAU. Measures (patient self-reports and clinician reports, patients' records, and register data) are collected at baseline, after the first and last meeting, and at 2, 4, 8, 12, and 24 months after inclusion. Some participants will be invited to participate in qualitative interviews. TRIAL DESIGN The study is a single-centre, non-blinded, RCT with two conditions involving a longitudinal and mixed design (quantitative and qualitative data). DISCUSSION This study will examine an intervention designed to determine early on which patients will benefit from parallel or other measures than assessment and treatment in CMHC and whether these will facilitate their recovery. Findings may potentially contribute to the development of the organisation of mental health services. TRIAL REGISTRATION ClinicalTrials.gov NCT05087446. Registered on 21 October 2021.
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Affiliation(s)
- Camilla Angelsen Kvestad
- Nidelv Community Mental Health Center, Clinic of Mental Health, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Ingvild Rønneberg Holte
- Nidelv Community Mental Health Center, Clinic of Mental Health, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Solveig Klæbo Reitan
- Nidelv Community Mental Health Center, Clinic of Mental Health, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Charlotte S Chiappa
- Nidelv Community Mental Health Center, Clinic of Mental Health, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Gunn Karin Helle
- Nidelv Community Mental Health Center, Clinic of Mental Health, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Anne E Skjervold
- Nidelv Community Mental Health Center, Clinic of Mental Health, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Anne Marit A Rosenlund
- Nidelv Community Mental Health Center, Clinic of Mental Health, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Øyvind Watne
- Nidelv Community Mental Health Center, Clinic of Mental Health, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Heidi Brattland
- Nidelv Community Mental Health Center, Clinic of Mental Health, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jon Helle
- Nidelv Community Mental Health Center, Clinic of Mental Health, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Turid Follestad
- Clinical Research Unit Central Norway, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Karen Walseth Hara
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Trondheim, Norway
- Norwegian Labour and Welfare Administration Trøndelag, Trondheim, Norway
| | - Katrine Høyer Holgersen
- Nidelv Community Mental Health Center, Clinic of Mental Health, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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Mindlis I, Revenson TA. Above and Beyond Number of Illnesses: A Two-Sample Replication of Current Approaches to Depressive Symptoms in Multimorbidity. Clin Gerontol 2024:1-10. [PMID: 38431827 PMCID: PMC11369122 DOI: 10.1080/07317115.2024.2324323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
OBJECTIVES To expand current models of depressive symptoms in older adults with multimorbidity (MM) beyond the number of illnesses as a predictor of worsened mental health. METHODS Two-sample replication study of adults ≥62 years old with ≥ two chronic illnesses, who completed validated questionnaires assessing depressive symptoms, and disease- and treatment-related stressors. Data were analyzed using hierarchical linear regression. RESULTS The model of cumulative number of illnesses was worse at explaining variance in depressive symptoms (Sample 1 R2 = .035; Sample 2 R2 = .029), compared to models including disease- and treatment-related stressors (Sample 1 R2 = .37; Sample 2 R2 = .47). Disease-related stressors were the strongest factor associated with depressive symptoms, specifically, poor subjective cognitive function (Sample 1: b = -.202, p = .013; Sample 2: b = -.288, p < .001) and greater somatic symptoms (b = .455, p < .001; Sample 2: b = .355, p < .001). CONCLUSIONS Using the number of illnesses to understand depressive symptoms in MM is a limited approach. Models that move beyond descriptive relationships between MM and depressive symptoms are needed. CLINICAL IMPLICATIONS Providers should consider the role of somatic symptom management in patients with MM and depressive symptoms.
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Affiliation(s)
- Irina Mindlis
- Weill Cornell Medicine, Division of Geriatrics and Palliative Medicine, New York, NY
| | - Tracey A. Revenson
- Psychology, Hunter College and The Graduate Center, City University of New York, NY
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Mindlis I, Revenson TA, Erblich J, Fernández Sedano B. Multimorbidity and Depressive Symptoms in Older Adults: A Contextual Approach. THE GERONTOLOGIST 2023; 63:1365-1375. [PMID: 36516464 DOI: 10.1093/geront/gnac186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Among older adults, depressive symptoms increase with each chronic illness; however, specific disease-related stressors (e.g., pain) and contextual moderators (interpersonal, sociocultural, temporal) of this relationship remain understudied. We explored disease-related stressors associated with depressive symptoms and moderating effects of contextual factors on this relationship, guided by a social ecological framework. RESEARCH DESIGN AND METHODS Adults ≥62 years with multimorbidity (n = 366) completed validated scales assessing diagnoses, disease-related stressors (pain intensity, subjective cognitive function, physical function, somatic symptoms), and depressive symptoms. Moderators included age, expectations regarding aging, perceived social support, and difficulty affording medications. Data were analyzed using structural equation modeling. RESULTS Participants were 62-88 years old, with several comorbidities (M = 3.5; range: 2-9). As hypothesized, disease-related stressors were associated with depressive symptoms (b = 0.64, SE = 0.04, p < .001). The effect of disease-related stressors on depressive symptoms was greater among those reporting low social support (B = 0.70, SE = 0.06, p < .001) than for those reporting high social support (B = 0.46, SE = 0.06, p < .001). The negative effect of disease-related stressors on depressive symptoms was stronger for those with poorer expectations of aging (B = 0.68, SE = 0.07, p < .001), compared to those with more positive expectations (B = 0.47, SE = 0.06, p < .001). Age and difficulties affording medications were not significant moderators. DISCUSSION AND IMPLICATIONS Garnering social support and addressing low expectations for aging may prevent the detrimental effect of multimorbidity on mental health.
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Affiliation(s)
- Irina Mindlis
- Psychology Program, The Graduate Center, City University of New York, New York City, New York, USA
| | - Tracey A Revenson
- Psychology Program, The Graduate Center, City University of New York, New York City, New York, USA
- Psychology Department, Hunter College, City University of New York, New York City, New York, USA
| | - Joel Erblich
- Psychology Program, The Graduate Center, City University of New York, New York City, New York, USA
- Psychology Department, Hunter College, City University of New York, New York City, New York, USA
| | - Brandon Fernández Sedano
- Psychology Department, Hunter College, City University of New York, New York City, New York, USA
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Foley L, Doherty AS, Wallace E, Boland F, Hynes L, Murphy AW, Molloy GJ. Exploring the Multidimensional Relationship Between Medication Beliefs and Adherence to Medications Among Older Adults Living With Multimorbidity Using Polynomial Regression: An Observational Cohort Study. Ann Behav Med 2023; 57:561-570. [PMID: 37000216 PMCID: PMC10312300 DOI: 10.1093/abm/kaad004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND People living with multimorbidity may hold complex beliefs about medicines, potentially influencing adherence. Polynomial regression offers a novel approach to examining the multidimensional relationship between medication beliefs and adherence, overcoming limitations associated with difference scores. PURPOSE To explore the multidimensional relationship between medication beliefs and adherence among people living with multimorbidity. METHODS Secondary analysis was conducted using observational data from a cohort of older adults living with ≥2 chronic conditions, recruited from 15 family practices in Ireland in 2010 (n = 812) and followed up in 2012 (n = 515). Medication beliefs were measured with the Beliefs about Medicines Questionnaire-Specific. Adherence was assessed with the medication possession ratio using prescription data from the national primary care reimbursement service. Polynomial regression was used to explore the best-fitting multidimensional models for the relationship between (i) beliefs and adherence at baseline, and (ii) beliefs at baseline and adherence at follow-up. RESULTS Confirmatory polynomial regression rejected the difference-score model, and exploratory polynomial regression indicated quadratic models for both analyses. Reciprocal effects were present in both analyses (slope [Analysis 1]: β = 0.08, p = .007; slope [Analysis 2]: β = 0.07, p = .044), indicating that adherence was higher when necessity beliefs were high and concern beliefs were low. Nonreciprocal effects were also present in both analyses (slope [Analysis 1]: β = 0.05, p = .006; slope [Analysis 2]: β = 0.04, p = .043), indicating that adherence was higher when both necessity and concern beliefs were high. CONCLUSIONS Among people living with multimorbidity, there is evidence that the relationship between medication beliefs and adherence is multidimensional. Attempts to support adherence should consider the combined role of necessity and concern beliefs.
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Affiliation(s)
- Louise Foley
- School of Psychology, University of Galway, Galway, Ireland
| | - Ann S Doherty
- Department of General Practice, University College Cork, Cork, Ireland
| | - Emma Wallace
- Department of General Practice, University College Cork, Cork, Ireland
| | - Fiona Boland
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
- Data Science Centre, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - Lisa Hynes
- Croi Heart and Stroke Charity, Galway, Ireland
| | - Andrew W Murphy
- Discipline of General Practice, University of Galway, Galway, Ireland
- HRB Primary Care Clinical Trials Network Ireland, University of Galway, Galway, Ireland
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Wu Z, Lohmöller J, Kuhl C, Wehrle K, Jankowski J. Use of Computation Ecosystems to Analyze the Kidney-Heart Crosstalk. Circ Res 2023; 132:1084-1100. [PMID: 37053282 DOI: 10.1161/circresaha.123.321765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
The identification of mediators for physiologic processes, correlation of molecular processes, or even pathophysiological processes within a single organ such as the kidney or heart has been extensively studied to answer specific research questions using organ-centered approaches in the past 50 years. However, it has become evident that these approaches do not adequately complement each other and display a distorted single-disease progression, lacking holistic multilevel/multidimensional correlations. Holistic approaches have become increasingly significant in understanding and uncovering high dimensional interactions and molecular overlaps between different organ systems in the pathophysiology of multimorbid and systemic diseases like cardiorenal syndrome because of pathological heart-kidney crosstalk. Holistic approaches to unraveling multimorbid diseases are based on the integration, merging, and correlation of extensive, heterogeneous, and multidimensional data from different data sources, both -omics and nonomics databases. These approaches aimed at generating viable and translatable disease models using mathematical, statistical, and computational tools, thereby creating first computational ecosystems. As part of these computational ecosystems, systems medicine solutions focus on the analysis of -omics data in single-organ diseases. However, the data-scientific requirements to address the complexity of multimodality and multimorbidity reach far beyond what is currently available and require multiphased and cross-sectional approaches. These approaches break down complexity into small and comprehensible challenges. Such holistic computational ecosystems encompass data, methods, processes, and interdisciplinary knowledge to manage the complexity of multiorgan crosstalk. Therefore, this review summarizes the current knowledge of kidney-heart crosstalk, along with methods and opportunities that arise from the novel application of computational ecosystems providing a holistic analysis on the example of kidney-heart crosstalk.
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Affiliation(s)
- Zhuojun Wu
- Institute of Molecular Cardiovascular Research (Z.W., J.J.), Rheinisch-Westfälische Technische Hochschule Aachen University, Germany
- Department of Radiology (C.K.), Rheinisch-Westfälische Technische Hochschule Aachen University, Germany
| | - Johannes Lohmöller
- Medical Faculty, and Department of Computer Science, Communication and Distributed Systems (COMSYS) (J.L., K.W.), Rheinisch-Westfälische Technische Hochschule Aachen University, Germany
| | - Christiane Kuhl
- Department of Radiology (C.K.), Rheinisch-Westfälische Technische Hochschule Aachen University, Germany
| | - Klaus Wehrle
- Institute of Molecular Cardiovascular Research (Z.W., J.J.), Rheinisch-Westfälische Technische Hochschule Aachen University, Germany
- Medical Faculty, and Department of Computer Science, Communication and Distributed Systems (COMSYS) (J.L., K.W.), Rheinisch-Westfälische Technische Hochschule Aachen University, Germany
| | - Joachim Jankowski
- Institute of Molecular Cardiovascular Research (Z.W., J.J.), Rheinisch-Westfälische Technische Hochschule Aachen University, Germany
- Department of Pathology, Cardiovascular Research Institute Maastricht (CARIM), University of Maastricht, The Netherlands (J.J.)
- Aachen-Maastricht Institute for Cardiorenal Disease (AMICARE), University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Germany (J.J.)
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Whitmore C, Markle-Reid M, McAiney C, Fisher K, Ploeg J. How do individual, social, environmental, and resilience factors shape self-reported health among community-dwelling older adults: a qualitative case study. BMC Geriatr 2023; 23:8. [PMID: 36609212 PMCID: PMC9816521 DOI: 10.1186/s12877-023-03726-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 01/02/2023] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND While older adults are living longer, they often face health challenges, including living with multiple chronic conditions. How older adults respond and adapt to the challenges of multimorbidity to maintain health and wellness is of increasing research interest. Self-reported health, emerging as an important measure of health status, has broad clinical and research applications, and has been described as a predictor of future morbidity and mortality. However, there is limited understanding of how individual, social, and environmental factors, including those related to multimorbidity resilience, influence self-reported health among community-dwelling older adults (≥ 65 years). METHODS Informed by the Lifecourse Model of Multimorbidity Resilience, this explanatory case study research explored older adults' perceptions of how these factors influence self-reported health. Data were generated through semi-structured telephone interviews with community-dwelling older adults. RESULTS Fifteen older adults participated in this study. Four key themes, specific to how these older adults describe individual, social, environmental, and multimorbidity resilience factors as shaping their self-reported health, were identified: 1) health is a responsibility - "What I have to do"; 2) health is doing what you want to do despite health-related limitations - "I do what I want to do"; 3) the application and activation of personal strengths - "The way you think", and; 4) through comparison and learning from others - "Looking around at other people". These themes, while distinct, were found to be highly interconnected with recurring concepts such as independence, control, and psychological health and well-being, demonstrating the nuance and complexity of self-reported health. CONCLUSIONS Findings from this study advance understanding of the factors that influence assessments of health among community-dwelling older adults. Self-reported health remains a highly predictive measure of future morbidity and mortality in this population, however, there is a need for future research to contribute additional understanding in order to shape policy and practice.
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Affiliation(s)
- Carly Whitmore
- grid.25073.330000 0004 1936 8227School of Nursing, McMaster University, 1280 Main Street W., Hamilton, ON L8S 4K1 Canada
| | - Maureen Markle-Reid
- grid.25073.330000 0004 1936 8227School of Nursing, McMaster University, 1280 Main Street W., Hamilton, ON L8S 4K1 Canada
| | - Carrie McAiney
- grid.498777.2School of Public Health Sciences, University of Waterloo & Schlegel-University of Waterloo, Research Institute for Aging, 200 University Ave W., Waterloo, ON N2L 3G1 Canada
| | - Kathryn Fisher
- grid.25073.330000 0004 1936 8227School of Nursing, McMaster University, 1280 Main Street W., Hamilton, ON L8S 4K1 Canada
| | - Jenny Ploeg
- grid.25073.330000 0004 1936 8227School of Nursing, McMaster University, 1280 Main Street W., Hamilton, ON L8S 4K1 Canada
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Nelson MLA, Singh H, Nie J, MacDonald S, Bayley M, Fortin C, Upshur R. Comparing stroke rehabilitation inpatients and clinical trials eligibility criteria: A secondary chart review analysis revealing that most patients could have been excluded from rehabilitation trials based on comorbidity status. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2023; 13:26335565231211668. [PMID: 37927973 PMCID: PMC10624005 DOI: 10.1177/26335565231211668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 10/17/2023] [Indexed: 11/07/2023]
Abstract
Background The generalizability of treatments examined in rehabilitation randomized controls trials (RCTs) partly depend on the similarity between trial subjects and a stroke rehabilitation inpatient population. The aim of this study was to determine the proportion of stroke rehabilitation inpatients that would have been eligible or ineligible to participate in published stroke RCTs. Methods This was a secondary analysis of chart review data collected as part of an independent quality improvement initiative. Data pertaining to the characteristics of stroke rehabilitation inpatients (e.g. age, cognitive impairment, previous stroke, comorbidities) were extracted from the medical charts of patients consecutively admitted to an inpatient stroke rehabilitation unit at a large urban rehabilitation hospital in Canada. Using the exclusion criteria categories of stroke RCTs identified from a systematic scoping review of 428 RCTs, we identified how many stroke rehabilitation inpatients would have been eligible or ineligible to participate in stroke RCTs based on their age, cognitive impairment, previous stroke and presence of comorbidities. Results In total, 110 stroke rehabilitation inpatients were included. Twenty-four percent of patients were 80 years of age or older, 84.5% had queries or concerns regarding patient cognitive abilities, 28.0% had a previous stroke, and 31.8% had a severe stroke. Stroke rehabilitation inpatients had six comorbidities on average. Based on these factors, most stroke rehabilitation inpatients could have been excluded from stroke RCTs, with cognitive impairment the most common RCT exclusion criteria. Conclusions Changes to the design of RCTs would support the development of clinical practice guidelines that reflect stroke rehabilitation inpatient characteristics, enhancing equity, diversity, and inclusion within samples and the generalizability of results.
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Affiliation(s)
- Michelle LA Nelson
- Bridgepoint Collaboratory, Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Hardeep Singh
- Department of Occupational Science & Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Jason Nie
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Shannon MacDonald
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Hennick Bridgepoint Hospital, Sinai Health, Toronto, ON, Canada
| | - Mark Bayley
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | | | - Ross Upshur
- Bridgepoint Collaboratory, Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada
- Institute of Clinical Evaluative Science, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, ON, Canada
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Pavlova NT, Moss‐Morris R, Smith C, Carr E, Rayner L, Picariello F. The importance of illness severity and multimorbidity in the association between mental health and body weight in psoriasis: Cross-sectional and longitudinal analysis. SKIN HEALTH AND DISEASE 2022; 2:e117. [PMID: 36479273 PMCID: PMC9720224 DOI: 10.1002/ski2.117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 04/05/2022] [Accepted: 04/05/2022] [Indexed: 06/17/2023]
Abstract
Background High body weight is common in psoriasis and is associated with depression and anxiety. Past studies are mostly cross-sectional and may underestimate the role of demographic and illness-related factors in the association between mental health and body weight in psoriasis. Objectives This study explored the association between depression and anxiety with waist circumference and body mass index (BMI) cross-sectionally and at 12 months follow-up, adjusting for demographic and illness-related factors in people with psoriasis. Method Routine psoriasis care data were combined with data on depression and anxiety from a large specialist psoriasis centre. The analytical samples consisted of patients with complete data on either waist circumference (N = 326 at time 1; N = 191 at follow-up) or BMI (N = 399 at time 1; N = 233 at follow-up) and corresponding mental health, demographic, and illness-related information. Associations between weight-related outcomes and mental health variables were assessed at time one and at 12 months follow-up, after adjusting for demographic and illness-related factors. Results We found no evidence of associations between mental health and waist circumference or BMI, after adjusting for age, gender and illness-related factors. Higher age, male gender and illness-related factors, specifically multimorbidity and psoriasis severity, were positively associated with waist circumference and BMI at both time points. Conclusion This study revealed the important role of factors related to illness severity in body weight in psoriasis. The contribution of depression and anxiety to weight was not observed here likely due to the sample and methodology used. Future work should explore other psychosocial factors such as weight-related attitudes and emotional eating in the context of weight in psoriasis, to help inform the development of successful weight-management treatments.
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Affiliation(s)
- Neli T. Pavlova
- Health Psychology SectionPsychology DepartmentInstitute of Psychiatry Psychology and NeuroscienceKing's College LondonLondonUK
| | - Rona Moss‐Morris
- Health Psychology SectionPsychology DepartmentInstitute of Psychiatry Psychology and NeuroscienceKing's College LondonLondonUK
| | - Catherine Smith
- Health Psychology SectionPsychology DepartmentInstitute of Psychiatry Psychology and NeuroscienceKing's College LondonLondonUK
- Guy's and St Thomas' NHS Foundation TrustSt John's Institute of DermatologyLondonUK
| | - Ewan Carr
- Department of Biostatistics and Health InformaticsInstitute of Psychiatry Psychology and NeuroscienceKing's College LondonLondonUK
| | - Lauren Rayner
- Department of Psychological MedicineInstitute of Psychiatry Psychology and NeuroscienceKing's College LondonLondonUK
| | - Federica Picariello
- Health Psychology SectionPsychology DepartmentInstitute of Psychiatry Psychology and NeuroscienceKing's College LondonLondonUK
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11
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Suls JM, Alfano C, Yap C. Personalized (N-of-1) Trials for Patient-Centered Treatments of Multimorbidity. HARVARD DATA SCIENCE REVIEW 2022; 4:10.1162/99608f92.d99e6ff5. [PMID: 38009131 PMCID: PMC10673634 DOI: 10.1162/99608f92.d99e6ff5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023] Open
Abstract
Treatment of patients who suffer from concurrent health conditions is not well served by (1) evidence-based clinical guidelines that mainly specify treatment of single conditions and (2) conventional randomized controlled trials (RCTs) that identify treatments as safe and effective on average. Clinical decision-making based on the average patient effect may be inappropriate for treatment of those with multimorbidity who experience burdens and obstacles that may be unique to their personal situation. We describe how the personalized (N-of-1) trials can be integrated with an automatic platform and virtual/remote technologies to improve patient-centered care for those living with multimorbidity. To illustrate, we present a hypothetical clinical scenario-survivors of both coronavirus disease 2019 (COVID-19) and cancer who chronically suffer from sleeplessness and fatigue. Then, we will describe how the four standard phases of conventional RCT development can be modified for personalized trials and applied to the multimorbidity clinical scenario, outline how personalized trials can be adapted and extended to compare the benefits of personalized trials versus between-subject trial design, and explain how personalized trials can address special problems associated with multimorbidity for which conventional trials are poorly suited.
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Affiliation(s)
- Jerry M Suls
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health; Manhasset, NY, USA
| | - Catherine Alfano
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health; Manhasset, NY, USA
- Northwell Health Cancer Institute; Manhasset, NY, USA
| | - Christina Yap
- Clinical Trials and Statistics Unit, The Institute of Cancer Research; London, UK
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12
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Whitmore C, Markle-Reid M, McAiney C, Ploeg J, Griffith LE, Phillips SP, Wister A, Fisher K. Self-reported health and the well-being paradox among community-dwelling older adults: a cross-sectional study using baseline data from the Canadian Longitudinal Study on Aging (CLSA). BMC Geriatr 2022; 22:112. [PMID: 35144559 PMCID: PMC8832840 DOI: 10.1186/s12877-022-02807-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/02/2022] [Indexed: 11/30/2022] Open
Abstract
Background Self-reported health is a widely used epidemiologic measure, however, the factors that predict self-reported health among community-dwelling older adults (≥65 years), especially those with multimorbidity (≥2 chronic conditions), are poorly understood. Further, it is not known why some older adults self-report their health positively despite the presence of high levels of multimorbidity, a phenomenon known as the well-being paradox. The objectives of this study were to: 1) examine the factors that moderate or mediate the relationship between multimorbidity and self-reported health; 2) identify the factors that predict high self-reported health; and 3) determine whether these same factors predict high self-reported health among those with high levels of multimorbidity to better understand the well-being paradox. Methods A cross-sectional analysis of baseline data from the Canadian Longitudinal Study on Aging was completed (n = 21,503). Bivariate stratified analyses were used to explore whether each factor moderated or mediated the relationship between multimorbidity and self-reported health. Logistic regression was used to determine the factors that predict high self-reported health in the general population of community-dwelling older adults and those displaying the well-being paradox. Results None of the factors explored in this study moderated or mediated the relationship between multimorbidity and self-reported health, yet all were independently associated with self-reported health. The ‘top five’ factors predicting high self-reported health in the general older adult population were: lower level of multimorbidity (odds ratio [OR] 0.75, 95% confidence interval [CI] 0.74-0.76), female sex (OR 0.62, CI 0.57-0.68), higher Life Space Index score (OR 1.01, CI 1.01-1.01), higher functional resilience (OR 1.16, CI 1.14-1.19), and higher psychological resilience (OR 1.26, CI 1.23-1.29). These same ‘top five’ factors predicted high self-reported health among the subset of this population with the well-being paradox. Conclusions The factors that predict high self-reported health in the general population of older adults are the same for the subset of this population with the well-being paradox. A number of these factors are potentially modifiable and can be the target of future interventions to improve the self-reported health of this population. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02807-z.
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Affiliation(s)
- Carly Whitmore
- School of Nursing, McMaster University, 1280 Main Street W, Hamilton, Ontario, L8S 4K1, Canada.
| | - Maureen Markle-Reid
- School of Nursing, McMaster University, 1280 Main Street W, Hamilton, Ontario, L8S 4K1, Canada
| | - Carrie McAiney
- School of Public Health Sciences, University of Waterloo & Schlegel-University of Waterloo Research Institute for Aging, 200 University Ave W, Waterloo, Ontario, N2L 3G1, Canada
| | - Jenny Ploeg
- School of Nursing, McMaster University, 1280 Main Street W, Hamilton, Ontario, L8S 4K1, Canada
| | - Lauren E Griffith
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street W, Hamilton, Ontario, L8S 4K1, Canada
| | - Susan P Phillips
- School of Medicine, Queen's University, 220 Bagot St, Kingston, Ontario, K7L 5E9, Canada
| | - Andrew Wister
- Department of Gerontology, Simon Fraser University, 515 W Hastings St, Vancouver, British Columbia, V6B 5K3, Canada
| | - Kathryn Fisher
- School of Nursing, McMaster University, 1280 Main Street W, Hamilton, Ontario, L8S 4K1, Canada
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13
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Longoria AJ, Horton A, Swan AA, Kalvesmaki A, Pugh MJ. Effect of multimorbidity and psychosocial factors on posttraumatic stress symptoms among post-9/11 veterans. Rehabil Psychol 2022; 67:69-78. [PMID: 34726456 PMCID: PMC8813875 DOI: 10.1037/rep0000346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Examine the association of multimorbidity and psychosocial functioning with posttraumatic stress disorder (PTSD) symptom severity reported among post-9/11 veterans. METHOD This was a secondary analysis of survey data collected from a national sample of post-9/11 veterans with at least 3 years of Department of Veterans Affairs care, stratified by comorbidity trajectory and sex (N = 1,989). Comorbidity trajectories were derived by latent class analysis to develop probabilistic combinations of physical and mental health conditions in a previous effort (Pugh et al., 2016). In this study, linear models analyzed symptom severity reported on the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition by psychosocial factors (i.e., resilience, self-efficacy, and postdeployment social support) while controlling for sociodemographic characteristics and deployment experiences. RESULTS Veterans in the mental health, pain, and polytrauma clinical triad comorbidity trajectories reported more severe PTSD symptoms than the healthy comorbidity trajectory (p < .01). All psychosocial factors were significantly associated with PTSD symptom severity, accounting for nearly 43% of variability in follow-up analyses. Confidence in self-efficacy demonstrated the strongest association among them (p < .01). CONCLUSION Veterans experiencing multimorbidity, particularly mental health distress, reported greater PTSD symptom severity after controlling for psychosocial factors, sociodemographics, and deployment experiences. The salience of psychosocial factors in reported PTSD symptom severity underscores resilience, self-efficacy and social support as potential facilitators of functional reintegration following military service. Our analyses underscore the need to address the systemic barriers in health care access and delivery for minority patient populations in future investigations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Anthony J. Longoria
- Department of Psychology, the University of Texas at San Antonio, San Antonio TX
| | - Avery Horton
- Department of Psychology, the University of Texas at San Antonio, San Antonio TX
| | - Alicia A. Swan
- Department of Psychology, the University of Texas at San Antonio, San Antonio TX
- South Texas Veterans Health Care System, San Antonio TX
| | - Andrea Kalvesmaki
- University of Utah Medicine, Salt Lake City UT
- Salt Lake Veterans Health Care System, Salt Lake City UT
| | - Mary Jo Pugh
- University of Utah Medicine, Salt Lake City UT
- Salt Lake Veterans Health Care System, Salt Lake City UT
| | - Trajectories of Resilience and Complex Comorbidity Study Team
- Salt Lake Veterans Health Care System, Salt Lake City UT
- Departments of Epidemiology and Biostatistics, University of Texas Health San Antonio, San Antonio, TX
- Division of General and Hospital Medicine, University of Texas Health San Antonio, San Antonio, TX
- Department of Psychiatry, University of Texas Health San Antonio, San Antonio, TX
- Department of Rehabilitation Medicine, University of Texas Health San Antonio, San Antonio, TX
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14
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Dunn R, Clayton E, Wolverson E, Hilton A. Conceptualising comorbidity and multimorbidity in dementia: A scoping review and syndemic framework. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2022; 12:26335565221128432. [PMID: 36187908 PMCID: PMC9520180 DOI: 10.1177/26335565221128432] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Older people and people with dementia experience a high prevalence of multiple health conditions. The terms ‘comorbidity’ and ‘multimorbidity’ are often used interchangeably to describe this, however there are key conceptual differences between these terms and their definitions. This has led to issues in the validity and comparability of research findings, potentially inappropriate intervention development and differences in quality of health care. Objective To review how the terms ‘comorbidity’ and ‘multimorbidity’ are defined within peer-reviewed dementia research and propose an operational framework. Design A scoping review of definitions within dementia research was carried out. Searches took place across five databases: Academic Search Premier, CINAHL Complete, MEDLINE, PsycARTICLES and PsycINFO. PRISMA-ScR guidelines were followed. Results Content analysis revealed five key themes, showing significant overlap and inconsistencies from both within, and between, the comorbidity and multimorbidity definitions; 1. Number of conditions; 2. Type of health conditions; 3. The co-occurrence of conditions; 4. The inclusion of an index disease (or not); 5. Use of medical language. The analysis also revealed gaps in how the underlying concepts of the definitions relate to people with dementia living with multiple health conditions. Conclusion This scoping review found that current definitions of comorbidity and multimorbidity are heterogeneous, reductionist and disease-focussed. Recommendations are made on the design of research studies including transparency and consistency of any terms and definitions used. A syndemic framework could be a useful tool for researchers, clinicians and policy makers to consider a more holistic picture of a person with dementia’s health and wellbeing.
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15
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Nguyen VC, Park J. Relationships between Demographic Factors and Chronic Conditions with Disease Severities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111469. [PMID: 34769985 PMCID: PMC8583414 DOI: 10.3390/ijerph182111469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/15/2021] [Accepted: 10/29/2021] [Indexed: 11/29/2022]
Abstract
Disease severities are the outcomes of an inpatient visit classification that assigns a diagnostic related group, including risk of mortality and severity of illness. Although widely used in healthcare, the analysis of factors affecting disease severities has not been adequately studied. In this study, we analyze the relationships between demographics and chronic conditions and specify their influence on disease severities. Descriptive statistics are used to investigate the relationships and the prevalence of chronic conditions. To evaluate the influence of demographic factors and chronic conditions on disease severities, several multinomial logistic regression models are performed and prediction models for disease severities are conducted based on National Inpatient Sample data for 2016 provided by the Healthcare Cost and Utilization Project database in the United States. The rate of patients with a chronic illness is 88.9% and the rate of patients with more than two chronic conditions is 67.6%; further, the rate is 62.7% for females, 73.9% for males, and 90% for the elderly. A high level of disease severity commonly appears in patients with more than two chronic conditions, especially in the elderly. For patients without chronic conditions, disease severities show a lower or safe level, even in the elderly.
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16
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Foley L, Hynes L, Murphy AW, Molloy GJ. 'Just keep taking them, keep hoping they'll work': A qualitative study of adhering to medications for multimorbidity. Br J Health Psychol 2021; 27:691-715. [PMID: 34719079 DOI: 10.1111/bjhp.12568] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 08/26/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Compared to single diseases, health psychology reflects many areas of medical research by affording relatively less attention to the experiences of people self-managing multiple co-occurring conditions and, in particular, the experience of managing the associated complex medication regimens. This study aimed to explore the experience of self-managing multimorbidity among older adults, with a focus on medication adherence. DESIGN A qualitative approach was taken, using individual semi-structured interviews. METHODS Sixteen people with complex multimorbidity aged 65 years or older were recruited through general practice to take part in semi-structured interviews. Data were analysed following guidelines for reflexive thematic analysis. RESULTS Two themes were generated, with each theme comprising three subthemes. Theme one represents the amplified burden arising from multimorbidity that leads to unique challenges for self-management, such as integrating multiple medications into daily life, accumulating new symptoms and treatments, and managing evolving medication regimens. Theme two represents pathways towards relief that reduce this burden and promote medication adherence, such as prioritising certain conditions and treatments, resigning to the need for multiple medications, and identifying and utilising adherence supports. CONCLUSIONS We identified factors relevant to medication adherence for older adults with multimorbidity that go beyond single-disease influences and account for the amplified experience of chronic disease that multimorbidity can produce for some people. While evidence of single-disease influences remains fundamental to tailoring behavioural interventions to individuals, the impact of multimorbidity on medication adherence should be accounted for in research and practice.
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Affiliation(s)
- Louise Foley
- School of Psychology, National University of Ireland Galway, Ireland
| | - Lisa Hynes
- Croí Heart and Stroke Centre, Galway, Ireland
| | - Andrew W Murphy
- Discipline of General Practice, National University of Ireland Galway, Ireland.,HRB Primary Care Clinical Trials Network Ireland, National University of Ireland Galway, Ireland
| | - Gerard J Molloy
- School of Psychology, National University of Ireland Galway, Ireland
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17
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Merluzzi TV, Philip EJ, Gomer B, Heitzmann Ruhf CA, Kim D. Comorbidity, Functional Impairment, and Emotional Distress: A Coping Mediation Model for Persons With Cancer. Ann Behav Med 2021; 55:994-1004. [PMID: 33522569 DOI: 10.1093/abm/kaaa122] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Comorbid disease in cancer patients can substantially impact medical care, emotional distress, and mortality. However, there is a paucity of research on how coping may affect the relationship between comorbidity and emotional distress. PURPOSE The current study investigated whether the relations between comorbidity and emotional distress and between functional impairment and emotional distress were mediated by three types of coping: action planning (AP), support/advice seeking (SAS), and disengagement (DD). METHODS Four hundred and eighty-three persons with cancer completed a measure of functional impairment (Sickness Impact Profile), the Checklist of Comorbid Conditions, the Brief COPE, the Hospital Anxiety and Depression Scale, the Quality of Life Assessment for Cancer Survivors (Negative Feelings Scale), and the Distress Screening Schedule (Emotional Distress Scale). The latter three measures were used to form a latent construct representing the outcome, emotional distress. RESULTS Model comparison analysis indicated that the model with DD as a mediator had a better fit than models containing AP and SAS. DD mediated the relationship between functional impairment and emotional distress, so that engaging in DD was associated with greater distress. In addition, comorbidity and functional impairment were directly and positively related to emotional distress, but the relation between comorbidity and distress was not mediated by coping type. CONCLUSIONS Both comorbidity and functional impairment may be associated with distress, but disengagement coping only mediated the relation involving functional impairment and was positively associated with distress. Future studies can investigate whether teaching active coping or adaptive coping (e.g., through mindfulness exercises) can decrease distress in cancer patients, despite functional impairments.
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Affiliation(s)
- Thomas V Merluzzi
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Errol J Philip
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Brenna Gomer
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Carolyn A Heitzmann Ruhf
- Department of Psychiatry and Behavioral Science, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Dahyeon Kim
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
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18
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Hickson R, Marin MP, Dunn M. Minority Women. Clin Geriatr Med 2021; 37:523-532. [PMID: 34600719 DOI: 10.1016/j.cger.2021.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Perceptions of illness, pain, and death are not static. They vary among populations according to their cultural and biological characteristics. Older black and Hispanic/Latinx women are unique in their approach to health care with respect to mentation, mobility, medication adherence, and what matters to them. It is the complexity of these components, which affect the ability of these women to age gracefully.
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Affiliation(s)
- Renee Hickson
- Oak Street Healthcare, 4800 Chef Menteur Highway, New Orleans, LA 70126, USA.
| | - Monica Pernia Marin
- Department of Geriatrics and Palliative Medicine, The George Washington University, 2150 Pennsylvania Avenue Northwest, Washington, DC 20037, USA
| | - Marisa Dunn
- Jencare Senior Medical Center, 2124 Candler Road, Decatur, GA 30032, USA
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Chen DD, Zhang H, Cui N, Tang L, Shao J, Wang X, Wang D, Liu N, Ye Z. Cross-cultural adaptation and validation of the caregiver contribution to self-care of chronic illness inventory in China: a cross-sectional study. BMJ Open 2021; 11:e048875. [PMID: 34493514 PMCID: PMC8424873 DOI: 10.1136/bmjopen-2021-048875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Caregiver contribution (CC) is important for the self-care behaviors of chronic disease individuals, as it could enhance patient outcomes. Therefore, it is necessary to assess this CC by using a good validity and reliability instrument. The Caregiver Contribution to Self-Care Chronic Illness Inventory (CC-SC-CII) was designed to assess CC to self-care behaviors of patients with chronic illness in Italy. However, it was unclear whether this tool had sound psychometrics properties in the context of Chinese culture. Therefore, we performed the cross-cultural adaption of the CC-SC-CII and we tested its psychometric properties among Chinese caregivers of patients with chronic disease. DESIGN A cross-sectional observational design. SETTINGS Participants were recruited from communities and institutions in Pingdingshan, Henan Province, China. PARTICIPANTS 301 caregivers of care recipients with chronic disease completed the Chinese version of the CC-SC-CII (C-CC-SC-CII). PRIMARY AND SECONDARY OUTCOME MEASURES The content validity index of items (I-CVI), the scale content validity index-average (S-CVI/Ave), exploratory factor analysis, confirmatory factor analysis (CFA), internal consistency and item analysis were tested. RESULTS The range of I-CVI was between 0.833 and 1.00, and the score of S-CVI was 0.991. In CFA, the C-CC to self-care monitoring scale had satisfactory fit indices. However, the C-CC to self-care maintenance and management scales had unsupported fit indices. The reliability coefficients of C-CC-SC-CII were 0.792, 0.880 and 0.870 for its three scales. Item-total correlations were all over 0.590. Test-retest reliability showed that the range of intraclass correlation coefficients was from 0.728 to 0.783. CONCLUSION The C-CC-SC-CII has sound psychometrics characteristics and is a culturally appropriate and reliable instrument for assessing CC to the self-care behaviours of patients with chronic disease in China.
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Affiliation(s)
- Dan Dan Chen
- Nursing Department, Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Hui Zhang
- Nursing Department, Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Nianqi Cui
- Nursing Department, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Leiwen Tang
- Nursing Department, Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jing Shao
- School of Nursing, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xiyi Wang
- School of Nursing, Shanghai Jiao Tong University School of Nursing, Shanghai, China
| | - Dan Wang
- Nursing Department, Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Na Liu
- Thyroid&breast surgery, Chongqing Medical University Affiliated Second Hospital, Chongqing, China
| | - Zhihong Ye
- Nursing Department, Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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20
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Ketcher D, Otto AK, Vadaparampil ST, Heyman RE, Ellington L, Reblin M. The Psychosocial Impact of Spouse-Caregiver Chronic Health Conditions and Personal History of Cancer on Well-being in Patients With Advanced Cancer and Their Caregivers. J Pain Symptom Manage 2021; 62:303-311. [PMID: 33348028 PMCID: PMC8213866 DOI: 10.1016/j.jpainsymman.2020.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/01/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
CONTEXT Caregiving during advanced cancer presents many physical and psychological challenges, especially for caregivers who are coping with their own history of cancer or their own chronic health conditions. There is growing recognition that caregiver health and patient health are interdependent. OBJECTIVES The objective of this study was to use quantitative and interview data to examine and explore the impact of a caregiver's personal cancer history and chronic health conditions on the psychosocial well-being of both the caregiver and patient. METHODS This was a secondary analysis of data from 88 patients with advanced lung/gastrointestinal cancer and their spouse-caregivers. Participants self-reported subjective health, chronic health conditions (including cancer), anxiety and depression symptoms, and social support and social stress. Caregivers self-reported caregiving burden and preparedness for caregiving. Caregivers also completed semistructured interviews. RESULTS Participants were mostly white, non-Hispanic, and in their mid-60s. Caregivers reported 1.40 (SD = 1.14) chronic conditions on average; 11 reported a personal history of cancer ("survivor-caregivers"). The number of caregiver chronic health conditions was positively associated with patient depression symptoms. Patients of survivor-caregivers also reported more depression symptoms than patients of caregivers without cancer (t(85) = -2.35, P = 0.021). Survivor-caregivers reported higher preparedness for caregiving than caregivers without cancer (t(85) = -2.48, P = 0.015). Interview data enriched quantitative findings and identified factors that may drive patient depression, including emotions such as resentment or guilt. Experiencing cancer personally may provide caregivers unique insight into the patient experience. CONCLUSION Providers should be aware of caregiver chronic conditions and cancer history, given the potential negative effects on patient psychosocial well-being.
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Affiliation(s)
- Dana Ketcher
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
| | - Amy K Otto
- Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Susan T Vadaparampil
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA; Office of Community Outreach, Engagement, and Equity, Moffitt Cancer Center, Tampa, Florida, USA
| | - Richard E Heyman
- Family Translational Research Group, New York University, New York, New York, USA
| | - Lee Ellington
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Maija Reblin
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA.
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21
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Social Networks Consumption and Addiction in College Students during the COVID-19 Pandemic: Educational Approach to Responsible Use. SUSTAINABILITY 2020. [DOI: 10.3390/su12187737] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Within the framework of digital sustainability, the increase in Internet consumption, and especially online social networks, offers social benefits, but is not without its drawbacks. For example, it can lead to psychological and/or psychiatric disorders in some people. Numerous researches are highlighting the similarities of these addictions with the consumption of toxic substances. University students are heavy users of the Internet and, in certain situations, addiction to online social networks can be the result of depression, harassment, and anxiety, among others, affecting their daily life, including their academic responsibilities. In recent months, an anomaly has occurred that may have contributed to intensifying this problem, namely the confinement produced by the COVID-19 pandemic, which has affected the whole world to a greater or lesser extent. In this cross-sectional study, with a descriptive and quantitative methodology, students from 14 Spanish universities were investigated in the first wave of the COVID-19 pandemic in order to understand the effects of this situation on the problem described. The results show a high consumption of social networks during that time, with significant incidences of addiction. In parallel, the presence of comorbidity has been determined. In this scenario, it would be necessary to implement university educational programs to redirect these addictive behaviors, as well as preventative recommendations and actions to minimize negative impacts. This is a major problem that is growing, exacerbated by the global pandemic produced by the SARS-CoV-2 coronavirus. Situations of this gravity call for the development of preventive and educational measures for the responsible and sustainable use of ICT.
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Gonot-Schoupinsky FN, Garip G, Sheffield D. Laughter and humour for personal development: A systematic scoping review of the evidence. Eur J Integr Med 2020. [DOI: 10.1016/j.eujim.2020.101144] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wang X, Tang L, Howell D, Shao J, Qiu R, Zhang Q, Ye Z. Psychometric Testing of the Chinese Version of the Coping and Adaptation Processing Scale-Short Form in Adults With Chronic Illness. Front Psychol 2020; 11:1642. [PMID: 32849006 PMCID: PMC7396654 DOI: 10.3389/fpsyg.2020.01642] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 06/17/2020] [Indexed: 12/17/2022] Open
Abstract
Background Adaptive capacity may serve as an indicator of the individuals’ coping behaviors toward illness management and may contribute to day-to-day living with chronic illness and improved quality of life. Practical and well-constructed instruments for measuring adaptation have not been adequately explored. An English 15-item Coping and Adaptation Processing–Short Form (CAPS-SF) for assessing adaptation has been created and validated in line with the underlying tenets of Coping and Adaptation Processing theory, but there is no applicable Chinese version. Methods The CAPS-SF was translated and culturally adapted into simplified Chinese. Among Chinese adults with chronic illness, 81 patients were selected for cultural adaptation and 288 patients were approached for psychometric testing. Content validity was evaluated by an expert panel. Construct validity was tested by confirmatory factor analysis. Concurrent validity and predictive validity were analyzed by Spearman correlation coefficient. Reliability was assessed by internal consistency and test–retest coefficients. Floor/ceiling effect was calculated. Results Adequate content validity was ensured by the expert panel. A four-factor structure (resourceful and focused, self-initiated and knowing-based, physical and fixed, and positive and systematic) describing individuals’ coping strategies was identified and verified. Concurrent validity and predictive validity were demonstrated by strong correlations with the confrontation of coping mode (r = 0.46) and a quality-of-life measure (r = 0.58). The McDonald’s omega coefficient of total scale was 0.82. Split-half reliability and test–retest reliability were 0.87 and 0.87. No floor/ceiling effect was present. Conclusion The Chinese version CAPS-SF is a theoretically based and culturally acceptable instrument with sound psychometric properties. Further studies are advocated to refine its four-factor structure.
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Affiliation(s)
- Xiyi Wang
- Department of Nursing, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China
| | - Leiwen Tang
- Department of Nursing, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China
| | - Doris Howell
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Jing Shao
- Department of Nursing, Zhejiang University School of Medicine, Hangzhou, China
| | - Ruolin Qiu
- Department of Nursing, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China
| | - Qi Zhang
- Department of Nursing, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China
| | - Zhihong Ye
- Department of Nursing, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China.,Department of Nursing, Zhejiang University School of Medicine, Hangzhou, China
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The past, present, and future of the biopsychosocial model: A review of The Biopsychosocial Model of Health and Disease: New philosophical and scientific developments by Derek Bolton and Grant Gillett. NEW IDEAS IN PSYCHOLOGY 2020. [DOI: 10.1016/j.newideapsych.2019.100755] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Peart A, Barton C, Lewis V, Russell G. The experience of care coordination for people living with multimorbidity at risk of hospitalisation: an interpretative phenomenological analysis. Psychol Health 2020; 35:1228-1248. [PMID: 32208944 DOI: 10.1080/08870446.2020.1743293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: There is growing interest in improving the care of people living with multimorbidity who require care coordination to help manage their health and reduce risk of hospitalisation. There has been limited past research exploring experiences of care for people living with multimorbidity. This qualitative study sought to explore the care experience of people enrolled in a care coordination intervention.Design: We interviewed 23 people living with multimorbidity enrolled in a care coordination intervention to examine their perceptions of the care experience. We used interpretative phenomenological analysis to identify themes from participants' perspectives of involvement in their care, using information to make decisions, and the meanings they made of their care experiences.Results: We identified three master themes of the participants' experience of care: Needing expert guidance, Circle of care, and I want to be spoken to like a person. We discuss these findings in the context of the recent literature on person-centred care.Conclusion: Understanding participants' experience of care reinforces the need for person-centred approaches. These findings suggest care coordination offered to people living with multimorbidity can be implemented through practical support and information alongside establishing a relationship of trust.
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Affiliation(s)
- Annette Peart
- Department of General Practice, Monash University, Notting Hill, Australia
| | - Chris Barton
- Department of General Practice, Monash University, Notting Hill, Australia
| | - Virginia Lewis
- Australian Institute for Primary Care and Ageing, La Trobe University, Bundoora, Australia
| | - Grant Russell
- Department of General Practice, Monash University, Notting Hill, Australia
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Abstract
OBJECTIVE Multimorbidity is a robust predictor of disability in aging adults, but the mechanisms by which multimorbidity is disabling are not clear. Most existing research focuses on disease-specific phenomena, such as diminished lung capacity in chronic obstructive pulmonary disease, which can result in functional limitations. This review takes a different approach by highlighting the potential role of a biological process-inflammation-that is common to many chronic medical conditions and thus, from a medical perspective, relatively disease nonspecific. METHOD Beginning with a description of inflammation and its measurement, this paper will provide an overview of research on inflammation as a predictor of disease risk in healthy adults and of adverse outcomes (e.g., disability) in those with multimorbidity. RESULTS The discussion of inflammation is then situated in the context of biopsychosocial influences on health, as inflammation has been shown to be sensitive to a wide range of social and psychological processes that are thought to contribute to healthy aging, including successful adaptation to multimorbidity and reduced risk of disability. CONCLUSIONS Finally, implications of this broader perspective for interventions to improve outcomes in aging adults with multimorbidity are briefly considered. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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