1
|
Dixon J, Morton B, Nkhata MJ, Silman A, Simiyu IG, Spencer SA, Van Pinxteren M, Bunn C, Calderwood C, Chandler CIR, Chikumbu E, Crampin AC, Hurst JR, Jobe M, Kengne AP, Levitt NS, Moshabela M, Owolabi M, Peer N, Phiri N, Singh SJ, Tamuhla T, Tembo M, Tiffin N, Worrall E, Yongolo NM, Banda GT, Bickton F, Bilungula AMM, Bosire E, Chawani MS, Chinoko B, Chisala M, Chiwanda J, Drew S, Farrant L, Ferrand RA, Gondwe M, Gregson CL, Harding R, Kajungu D, Kasenda S, Katagira W, Kwaitana D, Mendenhall E, Mensah ABB, Mnenula M, Mupaza L, Mwakasungula M, Nakanga W, Ndhlovu C, Nkhoma K, Nkoka O, Opare-Lokko EA, Phulusa J, Price A, Rylance J, Salima C, Salimu S, Sturmberg J, Vale E, Limbani F. Interdisciplinary perspectives on multimorbidity in Africa: Developing an expanded conceptual model. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003434. [PMID: 39078807 PMCID: PMC11288440 DOI: 10.1371/journal.pgph.0003434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 06/11/2024] [Indexed: 08/02/2024]
Abstract
Multimorbidity is an emerging challenge for health systems globally. It is commonly defined as the co-occurrence of two or more chronic conditions in one person, but its meaning remains a lively area of academic debate, and the utility of the concept beyond high-income settings is uncertain. This article presents the findings from an interdisciplinary research initiative that drew together 60 academic and applied partners working in 10 African countries to answer the questions: how useful is the concept of multimorbidity within Africa? Can the concept be adapted to context to optimise its transformative potentials? During a three-day concept-building workshop, we investigated how the definition of multimorbidity was understood across diverse disciplinary and regional perspectives, evaluated the utility and limitations of existing concepts and definitions, and considered how to build a more context-sensitive, cross-cutting description of multimorbidity. This iterative process was guided by the principles of grounded theory and involved focus- and whole-group discussions during the workshop, thematic coding of workshop discussions, and further post-workshop development and refinement. Three thematic domains emerged from workshop discussions: the current focus of multimorbidity on constituent diseases; the potential for revised concepts to centre the priorities, needs, and social context of people living with multimorbidity (PLWMM); and the need for revised concepts to respond to varied conceptual priorities amongst stakeholders. These themes fed into the development of an expanded conceptual model that centres the catastrophic impacts multimorbidity can have for PLWMM, families and support structures, service providers, and health systems.
Collapse
Affiliation(s)
- Justin Dixon
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ben Morton
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Misheck J. Nkhata
- SHLS Nursing and Midwifery, Teesside University, Middlesborough, United Kingdom
| | - Alan Silman
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, United Kingdom
| | - Ibrahim G. Simiyu
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Stephen A. Spencer
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Myrna Van Pinxteren
- Faculty of Health Sciences, Department of Medicine and Chronic Disease Initiative for Africa, University of Cape Town, Cape Town, South Africa
| | - Christopher Bunn
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
- College of Social Sciences, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Claire Calderwood
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Clare I. R. Chandler
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Edith Chikumbu
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Amelia C. Crampin
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - John R. Hurst
- UCL Respiratory, University College London, London, United Kingdom
| | - Modou Jobe
- MRC Unit The Gambia at LSHTM, Banjul, The Gambia
| | - Andre Pascal Kengne
- Non-communicable Diseases Research Unit, South African Medical Research Council, Cape Town, Durban, South Africa
| | - Naomi S. Levitt
- Faculty of Health Sciences, Department of Medicine and Chronic Disease Initiative for Africa, University of Cape Town, Cape Town, South Africa
| | - Mosa Moshabela
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Mayowa Owolabi
- Centre for Genomic and Precision Medicine, University of Ibadan, Ibadan, Nigeria
| | - Nasheeta Peer
- Non-communicable Diseases Research Unit, South African Medical Research Council, Cape Town, Durban, South Africa
| | - Nozgechi Phiri
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Sally J. Singh
- Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom
| | - Tsaone Tamuhla
- South African National Bioinformatics Institute, University of the Western Cape, Cape Town, South Africa
| | - Mandikudza Tembo
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Nicki Tiffin
- South African National Bioinformatics Institute, University of the Western Cape, Cape Town, South Africa
| | - Eve Worrall
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Nateiya M. Yongolo
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Gift T. Banda
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Fanuel Bickton
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
- Department of Rehabilitation Sciences, The Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | - Edna Bosire
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
- SAMRC Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Marlen S. Chawani
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
- Health Economics and Policy Unit, The Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | - Mphatso Chisala
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Jonathan Chiwanda
- Department of Non-communicable Diseases, Ministry of Health, Lilongwe, Malawi
| | - Sarah Drew
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Lindsay Farrant
- Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Rashida A. Ferrand
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Mtisunge Gondwe
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Celia L. Gregson
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Richard Harding
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King’s College London, London, United Kingdom
| | - Dan Kajungu
- Makerere University Centre for Health and Population Research, Makerere University, Kampala, Uganda
| | - Stephen Kasenda
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | | | - Duncan Kwaitana
- Department of Family Medicine, The Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Emily Mendenhall
- Edmund A. Walsh School of Foreign Service, Georgetown University, Washington, DC, United States of America
| | - Adwoa Bemah Boamah Mensah
- Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Modai Mnenula
- College of Medicine, University of Malawi, Blantyre, Malawi
| | | | | | - Wisdom Nakanga
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
- Deanery of Clinical Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Chiratidzo Ndhlovu
- Internal Medicine Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Kennedy Nkhoma
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King’s College London, London, United Kingdom
| | - Owen Nkoka
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
- College of Social Sciences, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Edwina Addo Opare-Lokko
- Greater Accra Regional Hospital, Faculty of Family Medicine, Ghana College of Physicians and Surgeons, Accra, Ghana
| | - Jacob Phulusa
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
| | - Alison Price
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Jamie Rylance
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Charity Salima
- Achikondi Women and Community Friendly Health Services, Lilongwe, Malawi
| | - Sangwani Salimu
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Joachim Sturmberg
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
- International Society of Systems and Complexity Sciences for Health, Waitsfield, VT, United States of America
| | - Elizabeth Vale
- University of the Witwatersrand, Johannesburg, South Africa
| | - Felix Limbani
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
| |
Collapse
|
2
|
Joyce DD, Boehmer KR, Kamath CC, LaVecchia CM, Sharma V, Schulte PJ, Tilburt JC, Penson DF, Boorjian SA. Financial Toxicity Among Patients With Metastatic Prostate Cancer: A Mixed Methods Approach to Identify Effective Interventions. UROLOGY PRACTICE 2024; 11:640-652. [PMID: 38899638 PMCID: PMC11192241 DOI: 10.1097/upj.0000000000000589] [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: 01/08/2024] [Accepted: 04/05/2024] [Indexed: 06/21/2024]
Abstract
INTRODUCTION Financial toxicity associated with treatments for metastatic prostate cancer remains poorly defined. We sought to understand aspects of financial toxicity not captured in a commonly employed financial toxicity questionnaire and identify potential interventions to help alleviate financial toxicity through a convergent mixed methods approach. METHODS Patients seen at our institution's advanced prostate cancer clinic were approached for completion of the Comprehensive Score for Financial Toxicity (COST-FACIT) questionnaire (quantitative analysis). A maximal variation purposive sample was chosen to participate in focus group discussions (qualitative analysis). Conventional content analysis was performed using an inductive approach. COST-FACIT scores were compared between patients experiencing high and low financial toxicity using Wilcoxon rank sum test. RESULTS Three themes were identified through qualitative analysis: (1) workload, (2) coping strategies, and (3) communication. We found alignment with the existing theory of financial capacity across our findings. Two unique aspects of financial toxicity emerged that were not assessed quantitatively and deemed to be significant. Specifically, cost transparency (including health care teams knowledgeable about and willing to discuss costs) and inclusion of informal caregivers in financial toxicity screening and decision-making may guide future interventions aimed at limiting financial toxicity in this population. CONCLUSIONS Prolonged treatment courses involving multiple lines of treatment with varying costs result in distinct financial toxicity components for patients with metastatic prostate cancer that are not assessed with COST-FACIT. Improving cost transparency, health care team knowledge and engagement, and providing resources to support informal caregivers may have a significant impact on the financial toxicity experienced by these patients.
Collapse
Affiliation(s)
| | - Kasey R. Boehmer
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Celia C. Kamath
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Christina M. LaVecchia
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, Minnesota, United States of America
- Department of English, University of Cincinnati, Cincinnati, OH
| | - Vidit Sharma
- Department of Urology, Mayo Clinic, Rochester, MN
| | | | - Jon C. Tilburt
- Department of General Internal Medicine, Mayo Clinic, Scottsdale, AZ
| | - David F. Penson
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
- Geriatric Research Education and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN
| | | |
Collapse
|
3
|
Smith SK, Pryce H, O'Connell GB, Hussain S, Shaw R, Straus J. 'The burden is very much on yourself': A qualitative study to understand the illness and treatment burden of hearing loss across the life course. Health Expect 2024; 27:e14067. [PMID: 38715316 PMCID: PMC11076985 DOI: 10.1111/hex.14067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION Hearing loss is a chronic health condition that rises sharply with age. The way people respond to and cope with health conditions is influenced by their capacity to perform illness and treatment-related work. The aim was to explore the cumulative burdens of living with hearing loss and the resources mobilised to ease the burdens. METHODS A qualitative design was used with semi-structured interviews (online or in-person) with participants recruited through audiology services and nonclinical services, such as lip-reading classes. Forty-six participants with hearing loss aged between 16 and 96 years were interviewed. An abductive approach, informed by May et al.'s burden of treatment theory, was used to analyse the data. RESULTS The illness burden involved participants working to make sense of their hearing loss, engaging in emotional work in response to changes in sound, social interactions and identity and coping with the daily frustrations required to communicate with others. Abandonment and uncertainty characterised the treatment burden; participants engaged in emotional work to adjust to hearing technology and deal with the uncertainty of how their hearing might progress. To ameliorate the burdens, participants drew on internal resources (psychological, health literacy, cognitive) and external resources (social support, financial, information, technology). CONCLUSIONS The workload of hearing loss appears largely devolved to the patient and is not always visible. Our work indicates the need to widen approaches in audiological care through the implementation of lifeworld-led care, family-centred care and peer support to build support for those with hearing loss. PATIENT OR PUBLIC CONTRIBUTION We developed the project in consultation with members of the public who have lived experience of hearing loss recruited through Aston University and volunteer links to audiology services. We also consulted people more likely to be affected by hearing loss adults including adults with learning disabilities, older adults in residential care and people from South Asia (Bangladeshi, Indian and Pakistani communities). These individuals commented on the study aims, interview schedule and participant recruitment practices. One of our co-authors (expert by experience) contributed to the development and interpretation of themes and preparation of the final manuscript.
Collapse
Affiliation(s)
- Sian K. Smith
- Department of Audiology, College of Health and Life SciencesAston UniversityBirminghamUK
| | - Helen Pryce
- Department of Audiology, College of Health and Life SciencesAston UniversityBirminghamUK
| | | | - Saira Hussain
- Department of Audiology, College of Health and Life SciencesAston UniversityBirminghamUK
| | - Rachel Shaw
- Aston Institute of Health and Neurodevelopment and School of Psychology, College of Health and Life SciencesAston UniversityBirminghamUK
| | - Jean Straus
- Department of Audiology, College of Health and Life SciencesAston UniversityBirminghamUK
| |
Collapse
|
4
|
Davies J, Remington A, Buckley C, Crane L, Smalley K. 'It seems like a luxury to be able to offer that': Factors influencing the implementation of annual health checks for autistic people in England. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:656-673. [PMID: 37431819 PMCID: PMC10913342 DOI: 10.1177/13623613231182011] [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: 07/12/2023]
Abstract
LAY ABSTRACT Autistic people are more likely to have mental and physical health problems than non-autistic people. Annual health checks could reduce these problems by finding and treating them early. Annual health checks are yearly medical appointments where a primary healthcare provider (such as a doctor or nurse) can check things like a patient's weight and heart rate and ask if they have any worries about their health. In this study, we wanted to understand what might encourage primary healthcare providers to use annual health checks with their autistic patients. First, we spoke to 10 autistic people and 11 primary healthcare providers. Using the findings from these conversations, we created an online survey for primary healthcare providers in England. We used the findings from the interviews and survey to help us understand what would encourage primary healthcare providers to offer annual health checks for autistic people. Our participants said that a lack of time and staff would make it hard to provide health checks. To help, they said other members of staff (such as nurses and healthcare assistants) could do the health checks, rather than doctors. They also said parts of the process could be made automatic to save time (e.g. sending automatic reminders). Knowledge about autism was important too (e.g. knowing about the common conditions autistic people have, and how to best support autistic patients). Participants said training on these topics, produced and delivered with autistic people, could encourage them to use annual health checks with their autistic patients.
Collapse
Affiliation(s)
| | | | | | | | - Katelyn Smalley
- University College London, UK
- University of Plymouth, UK
- Imperial College London
| |
Collapse
|
5
|
Pawar AS, Thorsteinsdottir B, Whitman S, Pine K, Lee A, Espinoza Suarez NR, Organick Lee P, Thota A, Lorenz E, Beck A, Albright R, Feely M, Williams A, Behnken E, Boehmer KR. Decisional Regret Surrounding Dialysis Initiation: A Comparative Analysis. Kidney Med 2024; 6:100785. [PMID: 38435065 PMCID: PMC10907211 DOI: 10.1016/j.xkme.2023.100785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 10/20/2023] [Accepted: 11/19/2023] [Indexed: 03/05/2024] Open
Abstract
Rationale & Objective Dialysis comes with a substantial treatment burden, so patients must select care plans that align with their preferences. We aimed to deepen the understanding of decisional regret with dialysis choices. Study Design This study had a mixed-methods explanatory sequential design. Setting & Participants All patients from a single academic medical center prescribed maintenance in-center hemodialysis or presenting for home hemodialysis or peritoneal dialysis check-up during 3 weeks were approached for survey. A total of 78 patients agreed to participate. Patients with the highest (15 patients) and lowest decisional regret (20 patients) were invited to semistructured interviews. Predictors Decisional regret scale and illness intrusiveness scale were used in this study. Analytical Approach Quantitatively, we examined correlations between the decision regret scale and illness intrusiveness scale and sorted patients into the highest and lowest decision regret scale quartiles for further interviews; then, we compared patient characteristics between those that consented to interview in high and low decisional regret. Qualitatively, we used an adapted grounded theory approach to examine differences between interviewed patients with high and low decisional regret. Results Of patients invited to participate in the interviews, 21 patients (8 high regret, 13 low regret) agreed. We observed that patients with high decisional regret displayed resignation toward dialysis, disruption of their sense of self and social roles, and self-blame, whereas patients with low decisional regret demonstrated positivity, integration of dialysis into their identity, and self-compassion. Limitations Patients with the highest levels of decisional regret may have already withdrawn from dialysis. Patients could complete interviews in any location (eg, home, dialysis unit, and clinical office), which may have influenced patient disclosure. Conclusions Although all patients experienced disruption after dialysis initiation, patients' approach to adversity differs between patients experiencing high versus low regret. This study identifies emotional responses to dialysis that may be modifiable through patient-support interventions.
Collapse
Affiliation(s)
- Aditya S. Pawar
- Beth Israel Deaconess Medical Center, Boston, MA
- Community Internal Medicine, Mayo Clinic, Rochester, MN
| | - Bjorg Thorsteinsdottir
- Community Internal Medicine, Mayo Clinic, Rochester, MN
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN
| | - Sam Whitman
- College of Health Solutions, Arizona State University, Phoenix, AZ
| | - Katherine Pine
- Human and Social Dimensions of Science and Technology, Arizona State University, Phoenix, AZ
| | - Alexander Lee
- Health Services Research, Mayo Clinic, Rochester, MN
| | - Nataly R. Espinoza Suarez
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN
- VITAM Research Center on Sustainable Health, Québec Integrated University Health and Social Services Center (CIUSSS de la Capitale-Nationale), Québec, Canada
| | - Paige Organick Lee
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN
| | - Anjali Thota
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN
| | | | | | | | | | - Amy Williams
- Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Emma Behnken
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN
| | - Kasey R. Boehmer
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN
| |
Collapse
|
6
|
de la Cuesta-Benjumea C, Hernádez-Ibarra LE, Arredondo-González CP. Living normally without being oneself: A qualitative study on the experience of living with advanced chronic kidney disease. PLoS One 2023; 18:e0295506. [PMID: 38128051 PMCID: PMC10734919 DOI: 10.1371/journal.pone.0295506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 11/27/2023] [Indexed: 12/23/2023] Open
Abstract
The aim of the study was to describe and analyze the experience of people with advanced chronic kidney disease. Chronic kidney disease is a growing public health problem that is on the increase worldwideThe experience of living with this illness is paradoxical, as it can include feelings of dependent autonomy, distant connection, abnormal normalcy, and uncertain hope. Every chronic disease involves a biographical alteration from the onset. For those who suffer it, it implies a breaking down and reconstruction of their everyday life. Despite the prevalence of the disease and the increase in the number of qualitative research studies in recent decades, there has not been much research on the experience of people with Chronic kidney disease. This is a qualitative study that began in 2018 and concluded in 2021.Twenty-one people with advanced chronic kidney disease were interviewed. They participated voluntarily with informed consent Participants were selected by purposive sampling. Data analysis was guided by grounded theory procedures using the Nvivo 12 software. This study reveals that people with advanced chronic kidney disease do not feel the same as they used to because their control over their lives is limited; because they feel their health is in a continuous state of deterioration; and because of the changes in themselves and in their relationships with others. With chronic kidney disease, their identity is continually called into question. The normal lives of these people-their biographical constructions-are precarious and are continuously being remodelled by the effects of treatment and the inexorable course of this disease. This study contributes to an understanding of the experience of people with advanced chronic kidney disease. It can contribute to helping health care professionals effectively support these patients in their efforts to lead a normal life and in making decisions about their treatment.
Collapse
|
7
|
Dalgarno E, McDermott I, Goff M, Spooner S, McBride A, Hodgson D, Donnelly A, Hogg J, Checkland K. The patient experience of skill mix changes in primary care: an in-depth study of patient 'work' when accessing primary care. J Public Health (Oxf) 2023; 45:i54-i62. [PMID: 38127564 PMCID: PMC10734673 DOI: 10.1093/pubmed/fdad203] [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: 02/02/2023] [Revised: 07/19/2023] [Accepted: 09/28/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND This paper presents insights into patient experiences of changes in workforce composition due to increasing deployment in general practice of practitioners from a number of different professional disciplines (skill mix). We explore these experiences via the concept of 'patient illness work'; how a patient's capacity for action is linked to the work arising from healthcare. METHODS We conducted four focus group interviews with Patient Participation Group members across participating English general practitioner practices. Thematic analysis and a theoretical lens of illness work were used to explore patients' attempts to understand and navigate new structures, roles and ways to access healthcare. RESULTS Participants' lack of knowledge about incoming practitioners constrained their agency in accessing primary care. They reported both increased and burdensome illness work as they were given responsibility for navigating and understanding new systems of access while simultaneously understanding new practitioner roles. CONCLUSIONS While skill mix changes were not resisted by patients, they were keen to improve their agency in capacity to access, by being better informed about newer practitioners to accept and trust them. Some patients require support to navigate change, especially where new systems demand specific capacities such as technological skills and adaptation to unfamiliar practitioners.
Collapse
Affiliation(s)
- Elizabeth Dalgarno
- Department of Public Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PT, UK
| | - Imelda McDermott
- Health Organisation, Policy and Economics (HOPE), Centre for Primary Care Research, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
| | - Mhorag Goff
- Health Organisation, Policy and Economics (HOPE), Centre for Primary Care Research, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
| | - Sharon Spooner
- Health Organisation, Policy and Economics (HOPE), Centre for Primary Care Research, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
| | - Anne McBride
- Institute of Health Policy and Management, Alliance Manchester Business School, University of Manchester, Manchester M13 9PT, UK
| | - Damian Hodgson
- The University of Sheffield, Management School, Sheffield, South Yorkshire, S10 2JA, UK
| | - Ailsa Donnelly
- The patient and public involvement and engagement group at The Centre for Primary Care and Health Services Research (Primer), The University of Manchester, Manchester, M13 9PL, UK
| | - Judith Hogg
- The patient and public involvement and engagement group at The Centre for Primary Care and Health Services Research (Primer), The University of Manchester, Manchester, M13 9PL, UK
| | - Kath Checkland
- Health Organisation, Policy and Economics (HOPE), Centre for Primary Care Research, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
| |
Collapse
|
8
|
Stewart J, Bradley J, Smith S, McPeake J, Walsh T, Haines K, Leggett N, Hart N, McAuley D. Do critical illness survivors with multimorbidity need a different model of care? Crit Care 2023; 27:485. [PMID: 38066562 PMCID: PMC10709866 DOI: 10.1186/s13054-023-04770-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
There is currently a lack of evidence on the optimal strategy to support patient recovery after critical illness. Previous research has largely focussed on rehabilitation interventions which aimed to address physical, psychological, and cognitive functional sequelae, the majority of which have failed to demonstrate benefit for the selected outcomes in clinical trials. It is increasingly recognised that a person's existing health status, and in particular multimorbidity (usually defined as two or more medical conditions) and frailty, are strongly associated with their long-term outcomes after critical illness. Recent evidence indicates the existence of a distinct subgroup of critical illness survivors with multimorbidity and high healthcare utilisation, whose prior health trajectory is a better predictor of long-term outcomes than the severity of their acute illness. This review examines the complex relationships between multimorbidity and patient outcomes after critical illness, which are likely mediated by a range of factors including the number, severity, and modifiability of a person's medical conditions, as well as related factors including treatment burden, functional status, healthcare delivery, and social support. We explore potential strategies to optimise patient recovery after critical illness in the presence of multimorbidity. A comprehensive and individualized approach is likely necessary including close coordination among healthcare providers, medication reconciliation and management, and addressing the physical, psychological, and social aspects of recovery. Providing patient-centred care that proactively identifies critical illness survivors with multimorbidity and accounts for their unique challenges and needs is likely crucial to facilitate recovery and improve outcomes.
Collapse
Affiliation(s)
- Jonathan Stewart
- Centre for Experimental Medicine, Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland.
| | - Judy Bradley
- Centre for Experimental Medicine, Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland
| | - Susan Smith
- Department of Public Health and Primary Care, Trinity College Dublin, Dublin 2, Ireland
| | - Joanne McPeake
- The Healthcare Improvement Studies Institute, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Timothy Walsh
- Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK
| | - Kimberley Haines
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Nina Leggett
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Nigel Hart
- Centre for Medical Education, Queen's University Belfast, Belfast, Northern Ireland
| | - Danny McAuley
- Centre for Experimental Medicine, Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland
| |
Collapse
|
9
|
Boehmer KR, Álvarez-Villalobos NA, Barakat S, de Leon-Gutierrez H, Ruiz-Hernandez FG, Elizondo-Omaña GG, Vaquera-Alfaro H, Ahn S, Spencer-Bonilla G, Gionfriddo MR, Millan-Alanis JM, Abdelrahim M, Prokop LJ, Murad MH, Wang Z. The impact of health and wellness coaching on patient-important outcomes in chronic illness care: A systematic review and meta-analysis. PATIENT EDUCATION AND COUNSELING 2023; 117:107975. [PMID: 37738790 PMCID: PMC10964774 DOI: 10.1016/j.pec.2023.107975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Health and Wellness Coaching (HWC) may be beneficial in chronic condition care. We sought to appraise its effectiveness on quality of life (QoL), self-efficacy (SE), depression, and anxiety. METHODS We searched MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane CENTRAL for randomized trials published January 2005 - March 2023 that compared HWC to standard clinical care or another intervention without coaching. We examined QoL, SE, depression, or anxiety outcomes. Meta-analysis utilizing the random-effects model was used to estimate the pooled standardized mean difference (SMD). RESULTS Thirty included studies demonstrated that HWC improved QoL within 3 months (SMD 0.62 95 % CI 0.22-1.02, p = 0.002), SE within 1.5 months (SMD 0.38, 95 % CI 0.03-0.73, p = 0.03), and depression at 3, 6, and 12 months (SMD 0.67, 95 % CI 0.13-1.20, p = 0.01), (SMD 0.72, 95 % CI 0.19-1.24, p = 0.006), and (SMD 0.41, 95 % CI 0.09-0.73, p = 0.01) Certainty in the evidence for most outcomes was either very low or low primarily due to the high risk of bias, heterogeneity, and imprecision. CONCLUSION HWC improves QoL, SE, and depression across chronic illness populations. Future research needs to standardize intervention reporting and outcome collection. PRACTICE IMPLICATIONS Future HWC studies should standardize intervention components, reporting, and outcome measures, apply relevant chronic illness theories, and aim to follow participants for greater than one year.
Collapse
Affiliation(s)
- Kasey R Boehmer
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA; Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA.
| | - Neri A Álvarez-Villalobos
- Plataforma INVEST-KER Unit Mayo Clinic (KER Unit Mexico), School of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo León, Mexico; School of Medicine and University Hospital "Dr. Jose E. Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo León, Mexico.
| | - Suzette Barakat
- Community Internal Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Humberto de Leon-Gutierrez
- School of Medicine and University Hospital "Dr. Jose E. Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo León, Mexico.
| | - Fernando G Ruiz-Hernandez
- School of Medicine and University Hospital "Dr. Jose E. Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo León, Mexico.
| | | | - Héctor Vaquera-Alfaro
- School of Medicine and University Hospital "Dr. Jose E. Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo León, Mexico.
| | - Sangwoo Ahn
- University of Tennessee Knoxville, Knoxville, TN, USA.
| | | | - Michael R Gionfriddo
- Department of Pharmaceutical, Administrative and Social Sciences, School of Pharmacy, Duquesne University, Pittsburgh, PA, USA.
| | - Juan M Millan-Alanis
- Plataforma INVEST-KER Unit Mayo Clinic (KER Unit Mexico), School of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo León, Mexico.
| | | | | | - M Hassan Murad
- Evidence-based Practice Center and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
| | - Zhen Wang
- Evidence-based Practice Center and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|
10
|
Natvik E, Lavik KO, Ogden J, Strømmen M, Moltu C. The patient-practitioner interaction in post bariatric surgery consultations: an interpersonal process recall study. Disabil Rehabil 2023; 45:4440-4449. [PMID: 36484620 DOI: 10.1080/09638288.2022.2152876] [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: 06/10/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE The patient-practitioner relationship is fundamental to rehabilitation practice and patients' health and wellbeing. Dissonance between patients who have had bariatric surgery and health care practitioners about what supportive care and good outcomes are can undermine care. To address the mechanisms of this process, we conducted an Interpersonal Process Recall study. MATERIALS AND METHODS We interviewed patients (11), video recorded consultations (10), conducted video-assisted individual interviews with patients (10) and practitioners (11) and a dyadic data analysis. RESULTS We identified relational states and shifts in the clinical encounter 2-3 years post-surgery, described in themes: a) Playing by the Book - Making it Easier for Each Other, b) Down the Blind Alley - Giving up on Each Other, and c) Opposite Poles - Towards and Away from Each Other. CONCLUSIONS The post-surgery consultations facilitated responsibility for health and self-care but did not invite dialogues about the psychosocial burdens of living with obesity and undergoing bariatric surgery. Patients and practitioners tried to avoid creating conflict, which in turn seemed to foster distance, rather than human connection. This limits the encounter's benefit to both parties, leaving them frustrated and less willing to either meet again or take any gains into their future lives.IMPLICATIONS FOR REHABILITATIONIllness evokes feelings of stress and uncertainty and is experienced very differently from the perspective of patients and health care practitioners (HCPs), who encounter each other in a field fraught with tension.Bodily changes and difficult emotions related to food and eating are to be expected when undergoing bariatric surgery, and to explicitly "notice, name and validate" emotions can promote the patient's capacity to sustain self-care, lifestyle change, weight loss and health gains.Making interpersonal connection and interaction between patient and HCP the centre of bariatric aftercare can enhance engagement in and outcomes of the post-surgery clinical encounter.
Collapse
Affiliation(s)
- Eli Natvik
- The Centre for Health Research, District General Hospital of Førde, Førde, Norway
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway
| | - Kristina Osland Lavik
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway
- Department of Psychiatry, District General Hospital of Førde, Førde, Norway
| | - Jane Ogden
- Department of Psychology, University of Surrey, Guildford, England
| | - Magnus Strømmen
- Centre for Obesity Research, Clinic of Surgery, St. Olavs University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Christian Moltu
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway
- Department of Psychiatry, District General Hospital of Førde, Førde, Norway
| |
Collapse
|
11
|
Mbokazi N, van Pinxteren M, Murphy K, Mair FS, May CR, Levitt NS. Ubuntu as a mediator in coping with multimorbidity treatment burden in a disadvantaged rural and urban setting in South Africa. Soc Sci Med 2023; 334:116190. [PMID: 37659263 DOI: 10.1016/j.socscimed.2023.116190] [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: 02/02/2023] [Revised: 08/12/2023] [Accepted: 08/22/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND People living with multimorbidity in economically precarious circumstances in low- and middle-income countries (LMICs) experience a high workload trying to meet self-management demands. However, in countries such as South Africa, the availability of social networks and support structures may improve patient capacity, especially when networks are governed by cultural patterns linked to the Pan-African philosophy of Ubuntu, which promotes solidarity through humanness and human dignity. We explore the mediating role Ubuntu plays in people's ability to self-manage HIV/NCD multimorbidity in underprivileged settings in urban and rural South Africa. METHODS We conducted semi-structured interviews with 30 patients living with HIV/NCD multimorbidity between February-April 2022. Patients attended public health clinics in Gugulethu, Cape Town and Bulungula, Eastern Cape. We analysed interviews using framework analysis, using the Cumulative Complexity Model (CuCoM) and Burden of Treatment Theory (BoTT) as frameworks through which to conceptualise the data. RESULTS Despite facing economic hardship, people with multimorbidity in South Africa were able to cope with their workload. They actively used and mobilized family relations and external networks that supported them financially, practically, and emotionally, allowing them to better self-manage their chronic conditions. Embedded in their everyday life, patients, often unconsciously, embraced Ubuntu and its core values, including togetherness, solidarity, and receiving Imbeko (respect) from health workers. This enabled participants to share their treatment workload and increase self-management capacity. CONCLUSION Ubuntu is an important mediator for people living with multimorbidity in South Africa, as it allows them to navigate their treatment workload and increase their social capital and structural resilience, which is key to self-management capacity. Incorporating Ubuntu and linked African support theories into current treatment burden models will enable better understandings of patients' collective support and can inform the development of context-specific social health interventions that fit the needs of people living with chronic conditions in African settings.
Collapse
Affiliation(s)
- Nonzuzo Mbokazi
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, South Africa
| | - Myrna van Pinxteren
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, South Africa.
| | - Katherine Murphy
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, South Africa
| | - Frances S Mair
- Institute of Health and Well-Being, University of Glasgow, Scotland, UK
| | - Carl R May
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, NIHR North Thames Applied Research Collaboration, UK
| | - Naomi S Levitt
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, South Africa
| |
Collapse
|
12
|
May CR, Chew-Graham CA, Gallacher KI, Gravenhorst KC, Mair FS, Nolte E, Richardson A. EXPERTS II - How are patient and caregiver participation in health and social care shaped by experienced burden of treatment and social inequalities? Protocol for a qualitative synthesis. NIHR OPEN RESEARCH 2023; 3:31. [PMID: 37881470 PMCID: PMC10593344 DOI: 10.3310/nihropenres.13411.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 10/27/2023]
Abstract
Background The workload health and social care service users and caregivers take on, and their capacity to do this work is important. It may play a key part in shaping the implementation of innovations in health service delivery and organisation; the utilisation and satisfaction with services; and the outcomes of care. Previous research has often focused on experiences of a narrow range of long-term conditions, and on factors that shape adherence to self-care regimes. Aims With the aim of deriving policy and practice implications for service redesign, this evidence synthesis will extend our understanding of service user and caregiver workload and capacity by comparing how they are revealed in qualitative studies of lived experience of three kinds of illness trajectories: long-term conditions associated with significant disability (Parkinson's disease, schizophrenia); serious relapsing remitting disease (Inflammatory Bowel Disease, bipolar disorder); and rapidly progressing acute disease (brain cancer, early onset dementia). Methods We will review and synthesise qualitative studies of lived experience of participation in health and social care that are shaped by interactions between experienced treatment burdens, social inequalities and illness trajectories. The review will involve: 1. Construction of a theory-informed coding manual; systematic search of bibliographic databases to identify, screen and quality assess full-text papers. 2. Analysis of papers using manual coding techniques, and text mining software; construction of taxonomies of service user and caregiver work and capacity. 3. Designing a model of core components and identifying common factors across conditions, trajectories, and contexts. 4. Work with practitioners, and a Patient and Public Involvement (PPI) group, to explore the validity of the models produced; to develop workload reduction strategies; and to consider person-centred service design. Dissemination We will promote workload reduction models to support service users and caregivers and produce policy briefs and peer-reviewed publications for practitioners, policy-makers, and researchers.
Collapse
Affiliation(s)
- Carl R May
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
- NIHR ARC North Thames, London, UK
| | | | | | - Katja C Gravenhorst
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
- NIHR ARC North Thames, London, UK
| | - Frances S Mair
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Ellen Nolte
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
- NIHR ARC North Thames, London, UK
| | - Alison Richardson
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR ARC Wessex, Southampton, UK
| |
Collapse
|
13
|
van Pinxteren M, Mbokazi N, Murphy K, Mair FS, May C, Levitt N. The impact of persistent precarity on patients' capacity to manage their treatment burden: A comparative qualitative study between urban and rural patients with multimorbidity in South Africa. Front Med (Lausanne) 2023; 10:1061190. [PMID: 37064034 PMCID: PMC10098191 DOI: 10.3389/fmed.2023.1061190] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 03/07/2023] [Indexed: 04/18/2023] Open
Abstract
Background People living with multimorbidity in low-and middle-income countries (LMICs) experience a high workload trying to meet the demands of self-management. In an unequal society like South Africa, many people face continuous economic uncertainty, which can impact on their capacity to manage their illnesses and lead to poor health outcomes. Using precariousness - the real and perceived impact of uncertainty - as a lens, this paper aims to identify, characterise, and understand the workload and capacity associated with self-management amongst people with multimorbidity living in precarious circumstances in urban and rural South Africa. Methods We conducted qualitative semi-structured interviews with 30 patients with HIV and co-morbidities between February and April 2021. Patients were attending public clinics in Cape Town (Western Cape) and Bulungula (Eastern Cape). Interviews were transcribed and data analysed using qualitative framework analysis. Burden of Treatment Theory (BoTT) and the Cumulative Complexity Model (CuCoM) were used as theoretical lenses through which to conceptualise the data. Results People with multimorbidity in rural and urban South Africa experienced multi-faceted precariousness, including financial and housing insecurity, dangerous living circumstances and exposure to violence. Women felt unsafe in their communities and sometimes their homes, whilst men struggled with substance use and a lack of social support. Older patients relied on small income grants often shared with others, whilst younger patients struggled to find stable employment and combine self-management with family responsibilities. Precariousness impacted access to health services and information and peoples' ability to buy healthy foods and out-of-pocket medication, thus increasing their treatment burden and reducing their capacity. Conclusion This study highlights that precariousness reduces the capacity and increases treatment burden for patients with multimorbidity in low-income settings in South Africa. Precariousness is both accumulative and cyclic, as financial insecurity impacts every aspect of peoples' daily lives. Findings emphasise that current models examining treatment burden need to be adapted to accommodate patients' experiences in low-income settings and address cumulative precariousness. Understanding treatment burden and capacity for patients in LMICs is a crucial first step to redesign health systems which aim to improve self-management and offer comprehensive person-centred care.
Collapse
Affiliation(s)
- Myrna van Pinxteren
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Nonzuzo Mbokazi
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Katherine Murphy
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Frances S. Mair
- School of Health and Well-Being, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Carl May
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- NIHR North Thames Applied Research Collaboration, London, United Kingdom
| | - Naomi Levitt
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
14
|
Lawless MT, Tieu M, Chan RJ, Hendriks JM, Kitson A. Instruments Measuring Self-Care and Self-Management of Chronic Conditions by Community-Dwelling Older Adults: A Scoping Review. J Appl Gerontol 2023:7334648231161929. [PMID: 36880688 DOI: 10.1177/07334648231161929] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
Given the high prevalence of chronic conditions and multimorbidity in older adults, there is a need to better conceptualize and measure self-care and self-management to promote a person-centered approach. This scoping review aimed to identify and map instruments measuring self-care and self-management of chronic conditions by older adults. We searched six electronic databases, charted data from the studies and tools and reported the results in accordance with the PRISMA-ScR guidelines. A total of 107 articles (103 studies) containing 40 tools were included in the review. There was substantial variation in the tools in terms of their aims and scope, structure, theoretical foundations, how they were developed, and the settings in which they have been used. The quantity of tools demonstrates the importance of assessing self-care and self-management. Consideration of the purpose, scope, and theoretical foundation should guide decisions about tools suitable for use in research and clinical practice.
Collapse
Affiliation(s)
- Michael T Lawless
- Caring Futures Institute, College of Nursing and Health Sciences, 1065Flinders University, Adelaide, SA, Australia
| | - Matthew Tieu
- Caring Futures Institute, College of Nursing and Health Sciences, 1065Flinders University, Adelaide, SA, Australia.,College of Humanities, Arts and Social Sciences, 1065Flinders University, Adelaide, SA, Australia
| | - Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Sciences, 1065Flinders University, Adelaide, SA, Australia
| | - Jeroen M Hendriks
- Caring Futures Institute, College of Nursing and Health Sciences, 1065Flinders University, Adelaide, SA, Australia
| | - Alison Kitson
- Caring Futures Institute, College of Nursing and Health Sciences, 1065Flinders University, Adelaide, SA, Australia
| |
Collapse
|
15
|
Matthews KS, Rennoldson SC, Fraser SD. Influence of health-system change on treatment burden: a systematic review. Br J Gen Pract 2023; 73:e59-e66. [PMID: 36253115 PMCID: PMC9591018 DOI: 10.3399/bjgp.2022.0066] [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: 02/03/2022] [Accepted: 07/13/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Treatment burden is a patient-centred concept describing the effort required of people to look after their health and the impact this has on their functioning and wellbeing. High treatment burden is more likely for people with multiple long-term conditions (LTCs). Validated treatment burden measures exist, but have not been widely used in practice or as research outcomes. AIM To establish whether changes in organisation and delivery of health systems and services improve aspects contributing to treatment burden for people with multiple LTCs. DESIGN AND SETTING Systematic review of randomised controlled trials (RCTs) investigating the impact of system-level interventions on at least one outcome relevant to previously defined treatment burden domains among adults with ≥2 LTCs. METHOD The Embase, Ovid MEDLINE, and Web of Science electronic databases were searched for terms related to multimorbidity, system-level change, and treatment burden published between January 2010 and July 2021. Treatment burden domains were derived from validated measures and qualitative literature. Synthesis without meta-analysis (SWiM) methodology was used to synthesise results and study quality was assessed using the Cochrane risk-of-bias (version 2) tool. RESULTS The searches identified 1881 articles, 18 of which met the review inclusion criteria. Outcomes were grouped into seven domains. There was some evidence for the effect of system-level interventions on some domains, but the studies exhibited substantial heterogeneity, limiting the synthesis of results. Some concern over bias gave low confidence in study results. CONCLUSION System-level interventions may affect some treatment burden domains. However, adoption of a standardised outcome set, incorporating validated treatment burden measures, and the development of standard definitions for care processes in future research would aid study comparability.
Collapse
|
16
|
Lippiett K, Richardson A, May CR. How do illness identity, patient workload and agentic capacity interact to shape patient and caregiver experience? Comparative analysis of lung cancer and chronic obstructive pulmonary disease. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4545-e4555. [PMID: 35633149 PMCID: PMC10084268 DOI: 10.1111/hsc.13858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 03/30/2022] [Accepted: 05/12/2022] [Indexed: 05/06/2023]
Abstract
Some patients have to work hard to manage their illness. When this work outweighs capacity (the resources available to patients to undertake the illness workload and other workloads such as that of daily life), this may result in treatment burden, associated with poor health outcomes for patients. This cross-sectional, comparative qualitative analysis uses an abductive approach to identify, characterise and explain treatment burden in chronic obstructive pulmonary disease (COPD) and lung cancer. It uses complementary qualitative methods (semi-structured interviews with patients receiving specialist care n = 19, specialist clinicians n = 5; non-participant observation of specialist outpatient consultations in two English hospitals [11 h, 52 min] n = 41). The findings underline the importance of the diagnostic process in relation to treatment burden; whether diagnosis is experienced as a biographically disruptive shock (as with lung cancer) or is insidiously biographically erosive (as with COPD).
Collapse
Affiliation(s)
- Kate Lippiett
- School of Health SciencesUniversity of SouthamptonSouthamptonUK
- NIHR Applied Research Collaboration WessexSouthamptonUK
| | - Alison Richardson
- School of Health SciencesUniversity of SouthamptonSouthamptonUK
- NIHR Applied Research Collaboration WessexSouthamptonUK
- University Hospital Southampton NHS Foundation TrustSouthamptonUK
| | - Carl R. May
- Faculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
- NIHR Applied Research Collaboration North ThamesLondonUK
| |
Collapse
|
17
|
Espinoza Suarez NR, LaVecchia CM, Morrow AS, Fischer KM, Kamath C, Boehmer KR, Brito JP. ABLE to support patient financial capacity: A qualitative analysis of cost conversations in clinical encounters. PATIENT EDUCATION AND COUNSELING 2022; 105:3249-3258. [PMID: 35918230 DOI: 10.1016/j.pec.2022.07.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 07/20/2022] [Accepted: 07/23/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To explore how costs of care are discussed in real clinical encounters and what humanistic elements support them. METHODS A qualitative thematic analysis of 41 purposively selected transcripts of video-recorded clinical encounters from trials run between 2007 and 2015. Videos were obtained from a corpus of 220 randomly selected videos from 8 practice-based randomized trials and 1 pre-post prospective study comparing care with and without shared decision making (SDM) tools. RESULTS Our qualitative analysis identified two major themes: the first, Space Needed for Cost Conversations, describes patients' needs regarding their financial capacity. The second, Caring Responses, describes humanistic elements that patients and clinicians can bring to clinical encounters to include good quality cost conversations. CONCLUSION Our findings suggest that strengthening patient-clinician human connections, focusing on imbalances between patient resources and burdens, and providing space to allow potentially unexpected cost discussions to emerge may best support high quality cost conversations and tailored care plans. PRACTICE IMPLICATIONS We recommend clinicians consider 4 aspects of communication, represented by the mnemonic ABLE: Ask questions, Be kind and acknowledge emotions, Listen for indirect signals and (discuss with) Every patient. Future research should evaluate the practicality of these recommendations, along with system-level improvements to support implementation of our recommendations.
Collapse
Affiliation(s)
- Nataly R Espinoza Suarez
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; VITAM - Centre for Sustainable Health Research, Laval University, Quebec, QC, Canada
| | | | - Allison S Morrow
- Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA; Milken Institute School of Public Health, The George Washington University, Washington DC, USA
| | - Karen M Fischer
- Division of Biomedical Statistics and Informatics, Mayo Clinic, MN, USA
| | - Celia Kamath
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Kasey R Boehmer
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
| | - Juan P Brito
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, MN, USA.
| |
Collapse
|
18
|
Soto C, Dixon-Woods M, Tarrant C. Families' experiences of central-line infection in children: a qualitative study. Arch Dis Child 2022; 107:1038-1042. [PMID: 35863869 PMCID: PMC9606494 DOI: 10.1136/archdischild-2022-324186] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/29/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Central venous access devices (CVADs), often known as central lines, are important for delivering medically complex care in children, and are increasingly used for children living at home. Central line-associated bloodstream infection (CLABSI) is a serious, life-threatening complication. Although the physical consequences of CLABSIs are well documented, families' views and experiences of CLABSI are poorly understood. DESIGN Qualitative study using semistructured interviews with participants from 11 families of a child living at home with a CVAD. PARTICIPANTS Parents of children aged 4-12 years living at home with a CVAD. Four fathers and nine mothers participated in interviews. RESULTS The risk of CLABSI is a constant fear for families of a child with a CVAD. Though avoiding infection is a key priority for families, it is not the only one: maintaining a sense of 'normal life' is another goal. Infection prevention and control require much work and expertise on the part of families, contributing significantly to families' physical and emotional workload. CONCLUSIONS Living with the risk of CLABSI poses additional burdens that impact on the physical and emotional well-being of families. Services to better support families to manage these burdens are needed.
Collapse
Affiliation(s)
- Carmen Soto
- Paediatric Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | | | | |
Collapse
|
19
|
Edwards ST, Greene L, Chaudhary C, Boothroyd D, Kinosian B, Zulman DM. Outpatient Care Fragmentation and Acute Care Utilization in Veterans Affairs Home-Based Primary Care. JAMA Netw Open 2022; 5:e2230036. [PMID: 36066895 PMCID: PMC9449785 DOI: 10.1001/jamanetworkopen.2022.30036] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/19/2022] [Indexed: 11/14/2022] Open
Abstract
Importance Veterans Affairs (VA) Home-Based Primary Care (HBPC) provides comprehensive, interdisciplinary primary care at home to patients with complex, chronic, disabling disease, but little is known about care fragmentation patterns and consequences among these patients. Objective To examine outpatient care fragmentation patterns and subsequent acute care among HBPC-engaged patients at high risk of hospitalization or death. Design, Setting, and Participants This retrospective cohort study included VA patients aged at least 65 years who were enrolled in the VA and Medicare, whose risk of hospitalization or death was in the top 10%, and who had at least 4 outpatient visits between October 1, 2013, and September 30, 2014. HBPC engagement was defined as having at least 2 HBPC encounters between July 1, 2014, and September 30, 2014. Data were analyzed from March 2020 to March 2022. Exposures Two indices of outpatient care fragmentation: practitioner count and the Usual Provider Continuity Index (UPC), based on VA and non-VA health care use from October 1, 2013, to September 30, 2014. All care delivered by HBPC clinicians was analyzed as coming from a single practitioner. Main Outcomes and Measures Emergency department (ED) visits and hospitalizations for ambulatory care sensitive conditions (ACSC) from VA records and Medicare claims from October 1, 2014, to September 30, 2015. Results Among 8908 identified HBPC patients, 8606 (96.6%) were male, 1562 (17.5%) were Black, 249 (2.8%) were Hispanic, 6499 (73.0%) were White, 157 (1.8%) were other race or ethnicity, and 441 (5.0%) had unknown race or ethnicity; the mean (SD) age was 80.0 (9.02) years; patients had a mean (SD) of 11.25 (3.87) chronic conditions, and commonly had disabling conditions such as dementia (38.8% [n = 3457]). In adjusted models, a greater number of practitioners was associated with increased odds of an ED visit (adjusted odds ratio [aOR], 1.05 [95% CI, 1.03-1.07]) and hospitalization for an ACSC (aOR, 1.04 [95% CI, 1.02-1.06]), whereas more concentrated care with a higher UPC was associated with reduced odds of these outcomes (highest vs lowest tertile of UPC: aOR for ED visit, 0.77 [95% CI, 0.67-0.88], aOR for ACSC hospitalization, 0.78 [95% CI, 0.68-0.88]). Conclusions and Relevance Among patients in HBPC, fragmented care was associated with more ED visits and ACSC hospitalizations. These findings suggest that consolidating or coordinating fragmented care may be a target for reducing preventable acute care.
Collapse
Affiliation(s)
- Samuel T. Edwards
- Section of General Internal Medicine, VA Portland Health Care System, Portland, Oregon
- General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon
| | - Liberty Greene
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Camila Chaudhary
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California
| | - Derek Boothroyd
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Bruce Kinosian
- Geriatrics Extended Care Data Analysis Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
- Perelman School of Medicine, Division of Geriatrics, University of Pennsylvania, Philadelphia
| | - Donna M. Zulman
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| |
Collapse
|
20
|
Skou ST, Mair FS, Fortin M, Guthrie B, Nunes BP, Miranda JJ, Boyd CM, Pati S, Mtenga S, Smith SM. Multimorbidity. Nat Rev Dis Primers 2022; 8:48. [PMID: 35835758 PMCID: PMC7613517 DOI: 10.1038/s41572-022-00376-4] [Citation(s) in RCA: 277] [Impact Index Per Article: 138.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 02/06/2023]
Abstract
Multimorbidity (two or more coexisting conditions in an individual) is a growing global challenge with substantial effects on individuals, carers and society. Multimorbidity occurs a decade earlier in socioeconomically deprived communities and is associated with premature death, poorer function and quality of life and increased health-care utilization. Mechanisms underlying the development of multimorbidity are complex, interrelated and multilevel, but are related to ageing and underlying biological mechanisms and broader determinants of health such as socioeconomic deprivation. Little is known about prevention of multimorbidity, but focusing on psychosocial and behavioural factors, particularly population level interventions and structural changes, is likely to be beneficial. Most clinical practice guidelines and health-care training and delivery focus on single diseases, leading to care that is sometimes inadequate and potentially harmful. Multimorbidity requires person-centred care, prioritizing what matters most to the individual and the individual's carers, ensuring care that is effectively coordinated and minimally disruptive, and aligns with the patient's values. Interventions are likely to be complex and multifaceted. Although an increasing number of studies have examined multimorbidity interventions, there is still limited evidence to support any approach. Greater investment in multimorbidity research and training along with reconfiguration of health care supporting the management of multimorbidity is urgently needed.
Collapse
Affiliation(s)
- Søren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark.
| | - Frances S Mair
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Martin Fortin
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Quebec, Canada
| | - Bruce Guthrie
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Bruno P Nunes
- Postgraduate Program in Nursing, Faculty of Nursing, Universidade Federal de Pelotas, Pelotas, Brazil
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Cynthia M Boyd
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Epidemiology and Health Policy & Management, Johns Hopkins University, Baltimore, MD, USA
| | - Sanghamitra Pati
- ICMR Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Sally Mtenga
- Department of Health System Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar Es Salaam, Tanzania
| | - Susan M Smith
- Discipline of Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Russell Building, Tallaght Cross, Dublin, Ireland
| |
Collapse
|
21
|
Heaf J, Heiro M, Petersons A, Vernere B, Povlsen JV, Sørensen AB, Clyne N, Bumblyte I, Zilinskiene A, Randers E, Løkkegaard N, Rosenberg M, Kjellevold S, Kampmann JD, Rogland B, Lagreid I, Heimburger O, Qureshi AR, Lindholm B. First-year mortality in incident dialysis patients: results of the Peridialysis study. BMC Nephrol 2022; 23:229. [PMID: 35761193 PMCID: PMC9235232 DOI: 10.1186/s12882-022-02852-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background Controversy surrounds which factors are important for predicting early mortality after dialysis initiation (DI). We investigated associations of predialysis course and circumstances affecting planning and execution of DI with mortality following DI. Methods Among 1580 patients participating in the Peridialysis study, a study of causes and timing of DI, we registered features of predialysis course, clinical and biochemical data at DI, incidence of unplanned suboptimal DI, contraindications to peritoneal dialysis (PD) or hemodialysis (HD), and modality preference, actual choice, and cause of modality choice. Patients were followed for 12 months or until transplantation. A flexible parametric model was used to identify independent factors associated with all-cause mortality. Results First-year mortality was 19.33%. Independent factors predicting death were high age, comorbidity, clinical contraindications to PD or HD, suboptimal DI, high eGFR, low serum albumin, hyperphosphatemia, high C-reactive protein, signs of overhydration and cerebral symptoms at DI. Among 1061 (67.2%) patients who could select dialysis modality based on personal choice, 654 (61.6%) chose PD, 368 (34.7%) center HD and 39 (3.7%) home HD. The 12-months survival did not differ significantly between patients receiving PD and in-center HD. Conclusions First-year mortality in incident dialysis patients was in addition to high age and comorbidity, associated with clinical contraindications to PD or HD, clinical symptoms, hyperphosphatemia, inflammation, and suboptimal DI. In patients with a “free” choice of dialysis modality based on their personal preferences, PD and in-center HD led to broadly similar short-term outcomes.
Collapse
|
22
|
Balakrishnan A, Weinmeyer R, Serper M, Bailey SC, Kaiser K, Wolf M. Navigating medication-taking after kidney transplant. Res Social Adm Pharm 2022; 18:3846-3854. [DOI: 10.1016/j.sapharm.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/03/2022] [Accepted: 05/14/2022] [Indexed: 10/18/2022]
|
23
|
Wannheden C, Åberg-Wennerholm M, Dahlberg M, Revenäs Å, Tolf S, Eftimovska E, Brommels M. Digital Health Technologies Enabling Partnerships in Chronic Care Management: A Scoping Review (Preprint). J Med Internet Res 2022; 24:e38980. [PMID: 35916720 PMCID: PMC9379797 DOI: 10.2196/38980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 06/02/2022] [Accepted: 06/16/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Carolina Wannheden
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Matilda Åberg-Wennerholm
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Marie Dahlberg
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Åsa Revenäs
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Division of Physiotherapy, School of Health Care and Social Welfare, Mälardalen University, Västerås, Sweden
- Center for Clinical Research, County of Västmanland, Uppsala University, Västerås, Sweden
| | - Sara Tolf
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Elena Eftimovska
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Mats Brommels
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
24
|
Hoover CG, Coller RJ, Houtrow A, Harris D, Agrawal R, Turchi R. Understanding Caregiving and Caregivers: Supporting Children and Youth With Special Health Care Needs at Home. Acad Pediatr 2022; 22:S14-S21. [PMID: 35248243 DOI: 10.1016/j.acap.2021.10.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/15/2021] [Accepted: 10/22/2021] [Indexed: 02/07/2023]
Abstract
Caregiving encompasses the nurturing, tasks, resources, and services that meet the day-to-day needs of children and youth with special health care needs (CYSHCN) at home. Many gaps exist in the strategies currently offered by the health care system to meet the caregiving needs of CYSHCN. The work of family caregivers of CYSHCN is known to be extensive, but it is so poorly understood that it has been described as "invisible". This invisibility leads to poor communication and gaps in understanding between professional health care providers and family caregivers. To address these gaps, health care researchers must work with family caregivers to incorporate their expertise on caregiving and create meaningful and sustainable research partnerships. A growing body of research is attempting to remedy the problem of caregiving invisibility and lay better foundations for successful integration between health care settings, family caregiving, professional caregiving, and community supports for families of CYSHCN. We identify high-priority gaps in CYSHCN caregiving research and propose research questions that are designed to accelerate growth in evidence-based understanding of the work of family caregivers of CYSHCN and how best to support them.
Collapse
Affiliation(s)
| | - Ryan J Coller
- Department of Pediatrics (RJ Coller), School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Win
| | - Amy Houtrow
- Department of Physical Medicine and Rehabilitation (A Houtrow), School of Medicine, University of Pittsburgh, Pittsburgh, Pa
| | - Debbi Harris
- Family Voices of Minnesota (D Harris), Stillwater, Minn
| | - Rishi Agrawal
- Division of Hospital-Based Medicine (R Agrawal), Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Renee Turchi
- Department of Pediatrics (R Turchi), College of Medicine, Drexel University, Philadelphia Pa
| |
Collapse
|
25
|
Eton DT, Anderson RT, St Sauver JL, Rogers EA, Linzer M, Lee MK. Longitudinal trajectories of treatment burden: A prospective survey study of adults living with multiple chronic conditions in the midwestern United States. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2022; 12:26335565221081291. [PMID: 35586037 PMCID: PMC9106306 DOI: 10.1177/26335565221081291] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/31/2022] [Indexed: 11/26/2022]
Abstract
Objectives Determine whether there are different longitudinal patterns of treatment burden in people living with multiple chronic conditions (MCC) and, if so, explore predictors that might reveal potential routes of intervention. Methods We analyzed data from a prospective mailed survey study of 396 adults living with MCC in southeastern Minnesota, USA. Participants completed a measure of treatment burden, the Patient Experience with Treatment and Self-management (PETS), and valid measures of health-related and psycho-social concepts at baseline, 6, 12, and 24 months. Latent class growth mixture modeling (LCGM) determined trajectories of treatment burden in two summary index scores of the PETS: Workload and Impact. Multivariable logistic regressions were used to identify independent predictors of the trajectories. Results LCGM supported a 2-class model for PETS Workload, including a group of consistently high workload (N = 69) and a group of consistently low workload (N = 311) over time. A 3-class model was supported for PETS Impact, including groups of consistently high impact (N = 62), consistently low impact (N = 278), and increasing impact (N = 51) over time. Logistic regression analyses showed that the following factors were associated with patterns of consistently high or increasing treatment burden over time: lower health literacy, lower self-efficacy, more interpersonal challenges with others, and worse subjective reports of physical and mental health (all p < .05). Conclusions Different longitudinal patterns of treatment burden exist among people with MCC. Raising health literacy, enhancing self-efficacy, and lessening the effects of negative social interactions might help reduce treatment burden.
Collapse
Affiliation(s)
- David T Eton
- Division of Health Care Delivery
Research, Robert D. and Patricia E. Kern Center for the Science of Health Care
Delivery, Mayo Clinic, Rochester, MN, USA,David T Eton, Division of Health Care
Delivery Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Roger T Anderson
- Department of Public Health
Sciences, University of Virginia School of
Medicine, Charlottesville, VA, USA
| | | | | | - Mark Linzer
- University of Minnesota Medical
School, Minneapolis, USA,Hennepin Healthcare, Minneapolis, MN, USA
| | - Minji K Lee
- Department of Quantitative Health
Sciences, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
26
|
Boehmer KR, Gallacher KI, Lippiett KA, Mair FS, May CR, Montori VM. Minimally Disruptive Medicine: Progress 10 Years Later. Mayo Clin Proc 2022; 97:210-220. [PMID: 35120690 DOI: 10.1016/j.mayocp.2021.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 09/03/2021] [Accepted: 09/13/2021] [Indexed: 12/17/2022]
Affiliation(s)
- Kasey R Boehmer
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA; Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA.
| | - Katie I Gallacher
- General Practice and Primary Care, University of Glasgow, Glasgow, UK
| | - Kate A Lippiett
- Macmillan Survivorship Research Group, University of Southampton, Southampton, UK
| | - Frances S Mair
- General Practice and Primary Care, University of Glasgow, Glasgow, UK
| | - Carl R May
- Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Victor M Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
27
|
Hardman R, Begg S, Spelten E. Exploring the ability of self-report measures to identify risk of high treatment burden in chronic disease patients: a cross-sectional study. BMC Public Health 2022; 22:163. [PMID: 35073896 PMCID: PMC8785389 DOI: 10.1186/s12889-022-12579-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 01/13/2022] [Indexed: 09/03/2023] Open
Abstract
Background Effective self-management of chronic health conditions is key to avoiding disease escalation and poor health outcomes, but self-management abilities vary. Adequate patient capacity, in terms of abilities and resources, is needed to effectively manage the treatment burden associated with chronic health conditions. The ability to measure different elements of capacity, as well as treatment burden, may assist to identify those at risk of poor self-management. Our aims were to: 1. Investigate correlations between established self-report tools measuring aspects of patient capacity, and treatment burden; and 2. Explore whether individual questions from the self-report tools will correlate to perceived treatment burden without loss of explanation. This may assist in the development of a clinical screening tool to identify people at risk of high treatment burden. Methods A cross-sectional survey in both a postal and online format. Patients reporting one or more chronic diseases completed validated self-report scales assessing social, financial, physical and emotional capacity; quality of life; and perceived treatment burden. Logistic regression analysis was used to explore relationships between different capacity variables, and perceived high treatment burden. Results Respondents (n = 183) were mostly female (78%) with a mean age of 60 years. Most participants were multimorbid (94%), with 45% reporting more than five conditions. 51% reported a high treatment burden. Following logistic regression analyses, high perceived treatment burden was correlated with younger age, material deprivation, low self-efficacy and usual activity limitation. These factors accounted for 50.7% of the variance in high perceived treatment burden. Neither disease burden nor specific diagnosis was correlated with treatment burden. Conclusions This study supports previous observations that psychosocial factors may be more influential than specific diagnoses for multimorbid patients in managing their treatment workload. A simple capacity measure may be useful to identify those who are likely to struggle with healthcare demands. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12579-1.
Collapse
|
28
|
Fang A, Abdelgadir D, Gopalan A, Ross T, Uratsu CS, Sterling SA, Grant RW, Iturralde E. Engaging patients in population-based chronic disease management: A qualitative study of barriers and intervention opportunities. PATIENT EDUCATION AND COUNSELING 2022; 105:182-189. [PMID: 33975772 PMCID: PMC8566319 DOI: 10.1016/j.pec.2021.04.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/05/2021] [Accepted: 04/29/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Cardiovascular disease (CVD) continues to be a leading cause of morbidity in the U.S. Managing CVD risk factors, such as diabetes or hypertension, can be challenging for many individuals. We investigated the barriers experienced by patients who persistently struggled to reach their CVD risk factor control goals. METHODS This qualitative study examined patient, clinician, and researcher observations of individuals' experiences in a chronic disease management program. All participants (n = 332) were enrolled in a clinical trial testing a skills-based group intervention seeking to improve healthcare engagement. Data were analyzed through a general inductive approach and resulting themes were structured along the Capability-Opportunity-Motivation-Behavior framework. RESULTS Analyses identified care engagement barriers related to participants' communication skills and activation, care team relationship processes, and emotional factors. Although most participants reported benefitting from skills training, persistent barriers included distrust of their providers, shame about health challenges, and dissatisfaction with care team interactions that were described as impersonal or unresponsive. CONCLUSIONS AND PRACTICE IMPLICATIONS Efforts to support engagement in CVD risk factor management programs should address whether patients and their care team have the necessary skills, opportunities and confidence to proactively communicate health needs and engage in non-judgmental interactions for goal-setting, rapport-building, and shared decision-making.
Collapse
Affiliation(s)
- Anya Fang
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Dana Abdelgadir
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Anjali Gopalan
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Thekla Ross
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Connie S Uratsu
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Stacy A Sterling
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Richard W Grant
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA.
| | - Esti Iturralde
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| |
Collapse
|
29
|
Ekstedt M, Kirsebom M, Lindqvist G, Kneck Å, Frykholm O, Flink M, Wannheden C. Design and Development of an eHealth Service for Collaborative Self-Management among Older Adults with Chronic Diseases: A Theory-Driven User-Centered Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010391. [PMID: 35010652 PMCID: PMC8744716 DOI: 10.3390/ijerph19010391] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 12/23/2021] [Accepted: 12/28/2021] [Indexed: 05/07/2023]
Abstract
The increasing prevalence of chronic conditions and multimorbidity poses great challenges to healthcare systems. As patients' engagement in self-managing their chronic conditions becomes increasingly important, eHealth interventions are a promising resource for the provision of adequate and timely support. However, there is inconclusive evidence about how to design eHealth services to meet the complex needs of patients. This study applied an evidence-based and theory-informed user-centered design approach in three phases to identify the needs of older adults and healthcare professionals in the collaborative management of multimorbidity (phase 1), develop an eHealth service to address these needs (phase 2), and test the feasibility and acceptance of the eHealth service in a clinical setting (phase 3). Twenty-two user needs were identified and a web-based application-ePATH (electronic Patient Activation in Treatment at Home)-with separate user interfaces for patients and healthcare professionals was developed. The feasibility study with two nurses and five patients led to a redesign and highlighted the importance of adequately addressing not only varying user needs but also the complex nature of healthcare organizations when implementing new services and processes in chronic care management.
Collapse
Affiliation(s)
- Mirjam Ekstedt
- Department Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, 171 77 Stockholm, Sweden;
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, 391 82 Kalmar, Sweden
- Correspondence: (M.E.); (C.W.); Tel.: +46-(0)480-44-63-99 (M.E.); +46-(0)8-524-839-34 (C.W.)
| | - Marie Kirsebom
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, 351 95 Växjö, Sweden; (M.K.); (G.L.)
| | - Gunilla Lindqvist
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, 351 95 Växjö, Sweden; (M.K.); (G.L.)
| | - Åsa Kneck
- Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stigbergsgatan 30, Box 111 89, 100 61 Stockholm, Sweden;
| | - Oscar Frykholm
- Department Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, 171 77 Stockholm, Sweden;
| | - Maria Flink
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 141 83 Stockholm, Sweden;
- Women’s Health and Allied Health Professionals Theme, Karolinska University Hospital, 141 86 Stockholm, Sweden
| | - Carolina Wannheden
- Department Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, 171 77 Stockholm, Sweden;
- Correspondence: (M.E.); (C.W.); Tel.: +46-(0)480-44-63-99 (M.E.); +46-(0)8-524-839-34 (C.W.)
| |
Collapse
|
30
|
Boehmer KR, Pine KH, Whitman S, Organick P, Thota A, Espinoza Suarez NR, LaVecchia CM, Lee A, Behnken E, Thorsteinsdottir B, Pawar AS, Beck A, Lorenz EC, Albright RC. Do patients with high versus low treatment and illness burden have different needs? A mixed-methods study of patients living on dialysis. PLoS One 2021; 16:e0260914. [PMID: 34962932 PMCID: PMC8714126 DOI: 10.1371/journal.pone.0260914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 11/21/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Approximately 750,000 people in the U.S. live with end-stage kidney disease (ESKD); the majority receive dialysis. Despite the importance of adherence to dialysis, it remains suboptimal, and one contributor may be patients' insufficient capacity to cope with their treatment and illness burden. However, it is unclear what, if any, differences exist between patients reporting high versus low treatment and illness burden. METHODS We sought to understand these differences using a mixed methods, explanatory sequential design. We enrolled adult patients receiving dialysis, including in-center hemodialysis, home hemodialysis, and peritoneal dialysis. Descriptive patient characteristics were collected. Participants' treatment and illness burden was measured using the Illness Intrusiveness Scale (IIS). Participants scoring in the highest quartile were defined as having high burden, and participants scoring in the lowest quartile as having low burden. Participants in both quartiles were invited to participate in interviews and observations. RESULTS Quantitatively, participants in the high burden group were significantly younger (mean = 48.4 years vs. 68.6 years respectively, p = <0.001). No other quantitative differences were observed. Qualitatively, we found differences in patient self-management practices, such as the high burden group having difficulty establishing a new rhythm of life to cope with dialysis, greater disruption in social roles and self-perception, fewer appraisal focused coping strategies, more difficulty maintaining social networks, and more negatively portrayed experiences early in their dialysis journey. CONCLUSIONS AND RELEVANCE Patients on dialysis reporting the greatest illness and treatment burden have difficulties that their low-burden counterparts do not report, which may be amenable to intervention.
Collapse
Affiliation(s)
- Kasey R. Boehmer
- Knoweldge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, Minnesota, United States of America
- * E-mail:
| | - Kathleen H. Pine
- College of Health Solutions, Arizona State University, Phoenix, Arizona, United States of America
| | - Samantha Whitman
- Human & Social Dimensions of Science & Technology, Arizona State University, Phoenix, Arizona, United States of America
| | - Paige Organick
- Knoweldge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Anjali Thota
- Knoweldge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Nataly R. Espinoza Suarez
- Knoweldge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Christina M. LaVecchia
- Knoweldge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, Minnesota, United States of America
- Neumann University, Aston, Pennsylvania, United States of America
| | - Alexander Lee
- Health Services Research, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Emma Behnken
- Knoweldge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Bjorg Thorsteinsdottir
- Knoweldge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, Minnesota, United States of America
- Community Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Aditya S. Pawar
- Neprhology and Hypertension, Mayo Clinic, Rochester, Minnesota, United States of America
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Annika Beck
- Bioethics, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Elizabeth C. Lorenz
- Neprhology and Hypertension, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Robert C. Albright
- Neprhology and Hypertension, Mayo Clinic, Rochester, Minnesota, United States of America
| |
Collapse
|
31
|
Brunelli VN, Beggs RL, Ehrlich CE. Case study discussion: The important partnership role of Disability Nurse Navigators in the context of abrupt system changes because of COVID-19 pandemic. Collegian 2021; 28:628-634. [PMID: 34924805 PMCID: PMC8669692 DOI: 10.1016/j.colegn.2021.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 04/06/2021] [Accepted: 04/28/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND Rapidly implementing telehealth-facilitated healthcare services in a COVID-19 environment generates relational challenges for people with intellectual disability. Disability Nurse Navigators assume a critical intermediary role between the healthcare system and this population. AIM To discuss the impact that rapid service change, in response to the COVID-19 pandemic, can have on people with disability and the work of Disability Nurse Navigators who support them. METHODS This clinical case discussion comprises two parts. First, a discussion on the impact that COVID-19 pandemic management has had on one person with an intellectual disability is framed using intersecting notions of cumulative complexity and Burden of Treatment Theory. Following, through a Latourian lens, the role of the Disability Nurse Navigator is explored. FINDINGS During COVID-19, telehealth has proved an important tool for healthcare continuity. Yet, for some people with some disabilities who live with additional and cumulative layers of health and social complexity, the healthcare workload that is transferred to them is exacerbated as they try to interact with disabling infrastructure. DISCUSSION The Disability Nurse Navigator recognises that people with disability are not independent of the technologies and structures that make up the healthcare system but that they are mutually constitutive. The Disability Nurse Navigator thus works to stabilise the relationships between changed service provision and the healthcare workload and capacity of people with disability. CONCLUSION The work of the Disability Nurse Navigator ultimately mitigated the disruption and additional treatment burden that is transferred to people with disability because of unintended consequences arising from the rapid introduction of service change.
Collapse
Affiliation(s)
- Vanessa N. Brunelli
- Nursing Practice Development Unit, Princess Alexandra Hospital, Metro South Health, Brisbane, Qld, Australia,Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Brisbane, Qld, Australia,Corresponding author at: 199 Ipswich Road, Woolloongabba 4102, Australia. Tel.: +61 731767289
| | - Rhonda L. Beggs
- Division of Medicine, Logan Hospital, Metro South Health, Brisbane, Qld, Australia
| | | |
Collapse
|
32
|
Hanlon P, Bryson I, Morrison H, Rafiq Q, Boehmer K, Gionfriddo MR, Gallacher K, May C, Montori V, Lewsey J, McAllister DA, Mair FS. Self-management interventions for Type 2 Diabetes: systematic review protocol focusing on patient workload and capacity support. Wellcome Open Res 2021; 6:257. [PMID: 35928807 PMCID: PMC9308000 DOI: 10.12688/wellcomeopenres.17238.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2021] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION People living with type 2 diabetes undertake a range of tasks to manage their condition, collectively referred to as self-management. Interventions designed to support self-management vary in their content, and efficacy. This systematic review will analyse self-management interventions for type 2 diabetes drawing on theoretical models of patient workload and capacity. METHODS AND ANALYSIS Five electronic databases (Medline, Embase, CENTRAL, CINAHL and PsycINFO) will be searched from inception to 27th April 2021, supplemented by citation searching and hand-searching of reference lists. Two reviewers will independently review titles, abstracts and full texts. Inclusion criteria include Population: Adults with type 2 diabetes mellitus; Intervention: Randomised controlled trials of self-management support interventions; Comparison: Usual care; Outcomes: HbA1c (primary outcome) health-related quality of life (QOL), medication adherence, self-efficacy, treatment burden, healthcare utilization (e.g. number of appointment, hospital admissions), complications of type 2 diabetes (e.g. nephropathy, retinopathy, neuropathy, macrovascular disease) and mortality; Setting: Community. Study quality will be assessed using the Effective Practice and Organisation of Care (EPOC) risk of bias tool. Interventions will be classified according to the EPOC taxonomy and the PRISMS self-management taxonomy and grouped into similar interventions for analysis. Clinical and methodological heterogeneity will be assessed within subgroups, and random effects meta-analyses performed if appropriate. Otherwise, a narrative synthesis will be performed. Interventions will be graded on their likely impact on patient workload and support for patient capacity. The impact of these theoretical constructs on study outcomes will be explored using meta-regression. Conclusion This review will provide a broad overview of self-management interventions, analysed within the cumulative complexity model theoretical framework. Analyses will explore how the workload associated with self-management, and support for patient capacity, impact on outcomes of self-management interventions. REGISTRATION NUMBER PROSPERO CRD42021236980.
Collapse
Affiliation(s)
- Peter Hanlon
- Institute for Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Iona Bryson
- Institute for Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Holly Morrison
- Institute for Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Qasim Rafiq
- Institute for Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Kasey Boehmer
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, USA
| | | | - Katie Gallacher
- Institute for Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Carl May
- London School of Hygiene and Tropical Medicine, London, UK
| | - Victor Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, USA
| | - Jim Lewsey
- Institute for Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Frances S Mair
- Institute for Health and Wellbeing, University of Glasgow, Glasgow, UK
| |
Collapse
|
33
|
Montori VM. Removing the blindfold: The centrality of care in caring for patients with multiple chronic conditions. Health Serv Res 2021; 56 Suppl 1:969-972. [PMID: 34378207 PMCID: PMC8515218 DOI: 10.1111/1475-6773.13865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 07/28/2021] [Accepted: 08/01/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- Victor M. Montori
- Knowledge and Evaluation Research UnitMayo ClinicRochesterMinnesotaUSA
| |
Collapse
|
34
|
Koopman WJ, LaDonna KA, Anne Kinsella E, Venance SL, Watling CJ. Getting airtime: Exploring how patients shape the stories they tell health practitioners. MEDICAL EDUCATION 2021; 55:1142-1151. [PMID: 33979015 DOI: 10.1111/medu.14561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 05/04/2021] [Accepted: 05/06/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Effective communication during health encounters is known to decrease patient complaints, increase patient adherence and optimise health outcomes. While the aim of patient-centred care is to find common ground, health practitioners tend to drive the encounter, often interrupting patients within the first minute of the clinical conversation. Optimal care for people with chronic illnesses requires individuals to interact with health practitioners regarding their health concerns, but given these constraints, we know little about how patients strategise conversations with their care providers. This understanding may further our efforts to educate health practitioners and trainees to learn and practice patient-centred care. METHODS A constructivist grounded theory approach with iterative data collection and analysis was used to explore the processes patients use to present and shape their stories for interactions with health practitioners. Twenty-one patients (n = 16 female; 5 male) representing a variety of chronic illnesses participated in semi-structured interviews. Using the constant comparative method of analysis, salient themes were ascertained. RESULTS Patients engage in extensive strategic preparations for productive health encounters. From the data, we identified four related elements comprising patients' process of planning, preparing, and strategising for health encounters: deciding to go, organising to get airtime, rehearsing a game plan, and anticipating external forces. By focusing on the extensive preparatory work patients engage in, our study expands the dimensions of how we understand illness-related work. Assembling personal health information, gathering disease information and achieving equanimity represent the dimensions of this 'health interaction work'. CONCLUSION The work patients engage in for health encounters is noteworthy yet often invisible. And work that is unseen may also be undervalued. Acknowledging, illuminating and valuing patients' preparatory work for health encounters add to how we understand patient-centred care, and this offers new targets for us to effectively teach and deliver it.
Collapse
Affiliation(s)
- Wilma J Koopman
- Health and Rehabilitation Sciences, Western University, London, ON, Canada
- London Health Sciences Centre, London, ON, Canada
| | - Kori A LaDonna
- Department of Innovation in Medical Education, University of Ottawa, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Elizabeth Anne Kinsella
- Health and Rehabilitation Sciences, Western University, London, ON, Canada
- Centre for Education Research & Innovation, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Faculty of Medicine and Health Sciences, Institute of Health Sciences Education, McGill University, Montreal, QC, Canada
| | - Shannon L Venance
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Christopher J Watling
- Centre for Education Research & Innovation, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| |
Collapse
|
35
|
Gao CC, Espinoza Suarez NR, Toloza FJK, Malaga Zuniga AS, McCarthy SR, Boehmer KR, Yao L, Fu S, Brito JP. Patients' Perspective About the Cost of Diabetes Management: An Analysis of Online Health Communities. Mayo Clin Proc Innov Qual Outcomes 2021; 5:898-906. [PMID: 34585085 PMCID: PMC8455864 DOI: 10.1016/j.mayocpiqo.2021.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To understand the perspectives of persons' living with diabetes about the increasing cost of diabetes management through an analysis of online health communities (OHCs) and the impact of persons' participation in OHCs on their capacity and treatment burden. Patients and Methods A qualitative study of 556 blog posts submitted between January 1, 2007 and December 31, 2017 to 4 diabetes social networking sites was conducted between March 2018 and July 2019. All posts were coded inductively using thematic analysis procedures. Eton's Burden of Treatment Framework and Boehmer's Theory of Patient Capacity directed triangulation of themes with existing theory. Results Three themes were identified: (1) cost barriers to care: participants describe individual and systemic cost barriers that inhibit prescribed therapy goals; (2) impact of financial cost on health: participants describe the financial effects of care on their physical and emotional health; and (3) saving strategies to overcome cost impact: participants discuss practical strategies that help them achieve therapy goals. Finally, we also identify that the use of OHCs serves to increase persons' capacity with the potential to decrease treatment burden, ultimately improving mental and physical health. Conclusion High cost for diabetes care generated barriers that negatively affected physical health and emotional states. Participant-shared experiences in OHCs increased participants' capacity to manage the burden. Potential solutions include cost-based shared decision-making tools and advocacy for policy change.
Collapse
Key Words
- BS, blood sugar
- BoTF, Burden of Treatment Framework
- DME, Durable Medical Equipment
- HMO, health maintenance organization
- IDDM, insulin-dependent diabetes mellitus
- IRB, institutional review board
- OHC, online health community
- PLWD, person living with diabetes
- PPA, Partnership for Prescription Assistance
- RX, prescription
- T1D, type 1 diabetes
- TPC, Theory of Patient Capacity
Collapse
Affiliation(s)
- Catherine C Gao
- Mayo Clinic Alix School of Medicine.,Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
| | | | - Freddy J K Toloza
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN.,Division of Endocrinology and Metabolism, University of Arkansas for Medical Sciences, Little Rock
| | - Ariana S Malaga Zuniga
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN.,Ruprecht-Karls University of Heidelberg, Heidelberg, Germany
| | - Sarah R McCarthy
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN.,Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Kasey R Boehmer
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
| | - Lixia Yao
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Sunyang Fu
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Juan P Brito
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN.,Department of Internal Medicine, Mayo Clinic, Rochester, MN
| |
Collapse
|
36
|
Homa K, Stevens G, Forcino R, Scalia P, Mertz P, Elwyn G. Assessing Shared Decision-Making in Cystic Fibrosis Care Using collaboRATE: A Cross-Sectional Study of 159 Programs. J Patient Exp 2021; 8:23743735211034032. [PMID: 34435088 PMCID: PMC8381423 DOI: 10.1177/23743735211034032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
There are numerous opportunities for shared decision-making (SDM) in cystic
fibrosis (CF) care, yet little is known about patients’ SDM experiences. This
study evaluated SDM across 159 CF care programs (4024 participants) in the
United States. Shared decision-making was assessed using the patient-reported
collaboRATE measure, which was included in the CF Foundation’s
Patient and Family Experience of Care Survey over 18 months. Overall, 69% of
respondents reported experiencing SDM. Respondents at pediatric programs were
more likely to experience SDM than those at adult programs (72% vs 67%,
P < .001). Multivariable logistic regression analyses
showed a relationship between SDM and patient age, whereby SDM was less likely
to occur with patients aged 18 to 24 years, compared to some younger and older
age groups (P = .02-<.001). Shared decision-making was more
likely to occur at pediatric programs when patients had better general health
(P = .02-<.01), and at pediatric and adult programs when
patients had better mental health (P = .02-<.001).
Disparities in SDM experiences highlight a need to improve decision-making
processes in CF care. Interventions tailored for improving SDM among specific
patient populations may be particularly advantageous.
Collapse
Affiliation(s)
- Karen Homa
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Gabrielle Stevens
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Rachel Forcino
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Peter Scalia
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Pamela Mertz
- Consultant with Cystic Fibrosis Foundation, Saint Michael, MN, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
| |
Collapse
|
37
|
Hardman R, Begg S, Spelten E. Multimorbidity and its effect on perceived burden, capacity and the ability to self-manage in a low-income rural primary care population: A qualitative study. PLoS One 2021; 16:e0255802. [PMID: 34370758 PMCID: PMC8351969 DOI: 10.1371/journal.pone.0255802] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 07/25/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Multimorbidity is increasing in prevalence, especially in low-income settings. Despite this, chronic conditions are often managed in isolation, potentially leading to burden-capacity imbalance and reduced treatment adherence. We aimed to explore, in a low-income population with common comorbidities, how the specific demands of multimorbidity affect burden and capacity as defined by the Cumulative Complexity Model. MATERIALS AND METHODS Qualitative interviews with thirteen rural community health centre patients in Victoria, Australia. Participants were aged between 47-72 years and reported 3-10 chronic conditions. We asked about perceived capacity and burden in managing health. The Theory of Patient Capacity was used to analyse capacity and Normalisation Process Theory to analyse burden. All data specifically associated with the experience of multimorbidity was extracted from each burden and capacity domain. RESULTS The capacity domains of biography, resource mobilisation and work realisation were important in relation to multimorbidity. Conditions causing functional impairment (e.g. chronic pain, depression) interacted with physical, psychological and financial capacity, leading to biographical disruption and an inability to realise treatment and life work. Despite this, few people had a treatment plan for these conditions. Participants reported that multimorbidity affected all burden domains. Coherence and appraisal were especially challenging due to condition interactions, with clinicians providing little guidance. DISCUSSION The capacity and burden deficits highlighted by participants were not associated with any specific diagnosis, but were due to condition interactions, coupled with the lack of health provider support to navigate interactions. Physical, psychological and financial capacities were inseparable, but rarely addressed or understood holistically. Understanding and managing condition and treatment interactions was a key burden task for patients but was often difficult, isolating and overwhelming. This suggests that clinicians should become more aware of linkages between conditions, and include generic, synergistic or cross-disciplinary approaches, to build capacity, reduce burden and encourage integrated chronic condition management.
Collapse
Affiliation(s)
- Ruth Hardman
- School of Rural Health, La Trobe University, Bendigo, Victoria, Australia
- Sunraysia Community Health Services, Mildura, Victoria, Australia
| | - Stephen Begg
- School of Rural Health, La Trobe University, Bendigo, Victoria, Australia
| | - Evelien Spelten
- School of Rural Health, La Trobe University, Bendigo, Victoria, Australia
| |
Collapse
|
38
|
Hardman R, Begg S, Spelten E. Healthcare professionals' perspective on treatment burden and patient capacity in low-income rural populations: challenges and opportunities. BMC FAMILY PRACTICE 2021; 22:50. [PMID: 33750306 PMCID: PMC7942213 DOI: 10.1186/s12875-021-01387-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/13/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND The challenges of chronic disease self-management in multimorbidity are well-known. Shippee's Cumulative Complexity Model provides useful insights on burden and capacity factors affecting healthcare engagement and outcomes. This model reflects patient experience, but healthcare providers are reported to have a limited understanding of these concepts. Understanding burden and capacity is important for clinicians, since they can influence these factors both positively and negatively. This study aimed to explore the perspectives of healthcare providers using burden and capacity frameworks previously used only in patient studies. METHODS Participants were twelve nursing and allied health providers providing chronic disease self-management support in low-income primary care settings. We used written vignettes, constructed from interviews with multimorbid patients at the same health centres, to explore how clinicians understood burden and capacity. Interviews were recorded and transcribed verbatim. Analysis was by the framework method, using Normalisation Process Theory to explore burden and the Theory of Patient Capacity to explore capacity. RESULTS The framework analysis categories fitted the data well. All participants clearly understood capacity and were highly conscious of social (e.g. income, family demands), and psychological (e.g. cognitive, mental health) factors, in influencing engagement with healthcare. Not all clinicians recognised the term 'treatment burden', but the concept that it represented was familiar, with participants relating it both to specific treatment demands and to healthcare system deficiencies. Financial resources, health literacy and mental health were considered to have the biggest impact on capacity. Interaction between these factors and health system barriers (leading to increased burden) was a common and challenging occurrence that clinicians struggled to deal with. CONCLUSIONS The ability of health professionals to recognise burden and capacity has been questioned, but participants in this study displayed a level of understanding comparable to the patient literature. Many of the challenges identified were related to health system issues, which participants felt powerless to address. Despite their awareness of burden and capacity, health providers continued to operate within a single-disease model, likely to increase burden. These findings have implications for health system organisation, particularly the need for alternative models of care in multimorbidity.
Collapse
Affiliation(s)
- Ruth Hardman
- La Trobe University Rural Health School, 471 Benetook Avenue, Mildura, VIC, 3500, Australia. .,Sunraysia Community Health Services, 137 Thirteenth Street, Mildura, VIC, 3500, Australia.
| | - Stephen Begg
- La Trobe Rural Health School, La Trobe University, PO Box 199, Bendigo, VIC, 3552, Australia
| | - Evelien Spelten
- La Trobe University Rural Health School, 471 Benetook Avenue, Mildura, VIC, 3500, Australia
| |
Collapse
|
39
|
Nordfonn OK, Morken IM, Bru LE, Larsen AI, Husebø AML. Burden of treatment in patients with chronic heart failure - A cross-sectional study. Heart Lung 2021; 50:369-374. [PMID: 33618147 DOI: 10.1016/j.hrtlng.2021.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 01/27/2021] [Accepted: 02/01/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Patients with heart failure (HF) must manage both a demanding treatment regimen and self-care, which may lead to a burden of treatment. The purpose of this study was to assess the levels of burdens from treatment and self-care and its associations with psychological distress and health-related quality of life. METHODS In this cross-sectional study we collected self-report data from 125 patients diagnosed with HF, New York Heart Association classification II and III, who received care in a nurse-led HF outpatient clinic. Clinical variables were collected from the medical records. Data analyses comprised descriptive statistics and partial correlations. RESULTS The participants mean age was 67 (±9.2), most were male (74,4%) and the majority had reduced ejection fraction (EF 35.4 ± 10.8). The highest mean burden scores emerged for insufficient medical information (34.65, range 0-86), difficulty with health care service (34.57, range 0-81), and physical and mental fatigue (34.12, range 0-90). Significant positive associations were observed between physical and mental fatigue from self-care, role and social activity limitation, and psychological distress, and health-related QoL. CONCLUSION Burden of treatment is an important aspect of HF treatment as it contributes to valuable knowledge on patient workload. This study emphasizes the need to simplify and tailor the treatment regimens to alleviate the burden.
Collapse
Affiliation(s)
- Oda Karin Nordfonn
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, PB 8600 Forus, 4016 Stavanger, Norway.
| | - Ingvild Margreta Morken
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, PB 8600 Forus, 4016 Stavanger, Norway; Department of Cardiology, Stavanger University Hospital, PB 8100, 4068 Stavanger, Norway
| | - Lars Edvin Bru
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, PB 8600 Forus, 4016 Stavanger, Norway
| | - Alf Inge Larsen
- Department of Cardiology, Stavanger University Hospital, PB 8100, 4068 Stavanger, Norway; Department of Clinical Science, University of Bergen, PB 7800, 5020 Bergen, Norway
| | - Anne Marie Lunde Husebø
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, PB 8600 Forus, 4016 Stavanger, Norway
| |
Collapse
|
40
|
El-Turk N, Chou MSH, Ting NCH, Girgis A, Vinod SK, Bray V, Dobler CC. Treatment burden experienced by patients with lung cancer. PLoS One 2021; 16:e0245492. [PMID: 33481895 PMCID: PMC7822249 DOI: 10.1371/journal.pone.0245492] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 01/04/2021] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Patients' burden from lung cancer treatment is not well researched, but this understanding can facilitate a patient-centred treatment approach. Current models of treatment burden suggest it is influenced by a patient's perception of their disease and treatment and their capacity to do the work required to treat their disease. METHODS Sixteen patients and 1 carer who were undergoing or had completed conventional or stereotactic ablative radiotherapy, chemotherapy or immunotherapy for lung cancer in the last 6 months participated in a semi-structured interview. A treatment burden framework was used with three main themes: a) treatment work, b) consequences of treatment and c) psychosocial factors affecting treatment burden. RESULTS The majority of patients did not feel unduly burdened by treatment tasks, despite having a large treatment-associated workload. Many saw treatment as a priority, causing them to restructure their life to accommodate for it. Patients wished that they would have been better informed about the lifestyle changes that they would have to make before treatment for lung cancer commenced and that the health service would provide services to assist them with this task. DISCUSSION While there was a large burden associated with lung cancer treatment, patients felt motivated and equipped to manage the workload because the disease was considered severe and life-threatening, and the treatment was seen as beneficial. Before initiating treatment for lung cancer, patients should be informed about lifestyle changes they likely have to make and should be offered assistance.
Collapse
Affiliation(s)
- Nicole El-Turk
- Department of Respiratory and Sleep Medicine, Liverpool Hospital, Sydney, NSW, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Michael S. H. Chou
- Department of Respiratory and Sleep Medicine, Liverpool Hospital, Sydney, NSW, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Natasha C. H. Ting
- Department of Respiratory and Sleep Medicine, Liverpool Hospital, Sydney, NSW, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Afaf Girgis
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
| | - Shalini K. Vinod
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
- Cancer Therapy Centre, Liverpool Hospital, Sydney, NSW, Australia
| | - Victoria Bray
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
- Cancer Therapy Centre, Liverpool Hospital, Sydney, NSW, Australia
| | - Claudia C. Dobler
- Department of Respiratory and Sleep Medicine, Liverpool Hospital, Sydney, NSW, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
- Institute for Evidence-Based Healthcare, Bond University and Gold Coast University Hospital, Gold Coast, QLD, Australia
| |
Collapse
|
41
|
Lesage A, Leclère B, Moret L, Le Glatin C. Decreasing patient-reported burden of treatment: A systematic review of quantitative interventional studies. PLoS One 2021; 16:e0245112. [PMID: 33434200 PMCID: PMC7802949 DOI: 10.1371/journal.pone.0245112] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 12/22/2020] [Indexed: 11/21/2022] Open
Abstract
Objectives To describe and analyse studies aiming at quantitatively assessing the impact of interventions on patient-reported burden of treatment as an outcome (primary or secondary). Methods The aim of the search strategy was to identify all publications describing a medical intervention intended to reduce patient-reported burden of treatment in adult patients with long-term conditions, from January 1, 2008 to July 15, 2019. Four databases (Medline, PsycINFO, the “Trials” section of the Cochrane-Library, and OpenGrey) were searched in English, French, Spanish, Italian and Portuguese. Each identified article was reviewed and the risk of bias was assessed using a tool adapted from the Cochrane Collaboration recommendations. Results Of 641 articles retrieved, 11 were included in this review. There were nine randomized controlled trials, one non-randomized controlled trial, and one before-and-after study. The sample sizes ranged from 55 to 1,546 patients. Eight out of the eleven studies reported significant positive outcomes of the studied interventions. Reducing dosing frequency, improving background therapy, offering home care or providing easier-to-use medical devices were associated with positive outcomes. Conclusions Only a few studies have specifically focused on decreasing the subjective burden of treatment. Small trials conducted in patients with a single specific disorder have reported positive outcomes. However, a large, high-quality study assessing the impact of a change in care process in patients with multiple morbidities did not show such results. Further studies are needed to implement this aspect of patient-centred care.
Collapse
Affiliation(s)
- Aurore Lesage
- Department of Medical Evaluation and Epidemiology, Nantes University Hospital, Nantes, France
| | - Brice Leclère
- Department of Medical Evaluation and Epidemiology, Nantes University Hospital, Nantes, France
- MiHAR Lab, University of Nantes, Nantes, France
| | - Leïla Moret
- Department of Medical Evaluation and Epidemiology, Nantes University Hospital, Nantes, France
- UMR INSERM 1246—MethodS in Patients-Centred Outcomes and HEalth ResEarch (SPHERE), University of Nantes, Nantes, France
| | - Clément Le Glatin
- Department of Medical Evaluation and Epidemiology, Nantes University Hospital, Nantes, France
- * E-mail:
| |
Collapse
|
42
|
Abu Dabrh AM, Boehmer KR, Shippee N, Rizza SA, Perlman AI, Dick SR, Behnken EM, Montori VM. Minimally disruptive medicine (MDM) in clinical practice: a qualitative case study of the human immunodeficiency virus (HIV) clinic care model. BMC Health Serv Res 2021; 21:24. [PMID: 33407451 PMCID: PMC7788961 DOI: 10.1186/s12913-020-06010-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 12/10/2020] [Indexed: 12/30/2022] Open
Abstract
Background Recent evidence suggests the need to reframe healthcare delivery for patients with chronic conditions, with emphasis on minimizing healthcare footprint/workload on patients, caregivers, clinicians and health systems through the proposed Minimally Disruptive Medicine (MDM) care model named. HIV care models have evolved to further focus on understanding barriers and facilitators to care delivery while improving patient-centered outcomes (e.g., disease progression, adherence, access, quality of life). It is hypothesized that these models may provide an example of MDM care model in clinic practice. Therefore, this study aimed to observe and ascertain MDM-concordant and discordant elements that may exist within a tertiary-setting HIV clinic care model for patients living with HIV or AIDS (PLWHA). We also aimed to identify lessons learned from this setting to inform improving the feasibility and usefulness of MDM care model. Methods This qualitative case study occurred in multidisciplinary HIV comprehensive-care clinic within an urban tertiary-medical center. Participants included Adult PLWHA and informal caregivers (e.g. family/friends) attending the clinic for regular appointments were recruited. All clinic staff were eligible for recruitment. Measurements included; semi-guided interviews with patients, caregivers, or both; semi-guided interviews with varied clinicians (individually); and direct observations of clinical encounters (patient-clinicians), as well as staff daily operations in 2015–2017. The qualitative-data synthesis used iterative, mainly inductive thematic coding. Results Researcher interviews and observations data included 28 patients, 5 caregivers, and 14 care-team members. With few exceptions, the clinic care model elements aligned closely to the MDM model of care through supporting patient capacity/abilities (with some patients receiving minimal social support and limited assistance with reframing their biography) and minimizing workload/demands (with some patients challenged by the clinic hours of operation). Conclusions The studied HIV clinic incorporated many of the MDM tenants, contributing to its validation, and informing gaps in knowledge. While these findings may support the design and implementation of care that is both minimally disruptive and maximally supportive, the impact of MDM on patient-important outcomes and different care settings require further studying. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-020-06010-x.
Collapse
Affiliation(s)
- Abd Moain Abu Dabrh
- Department of Family Medicine, Mayo Clinic Florida, 4500 San Pablo Rd S, Jacksonville, FL, USA. .,Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA. .,Integrative Medicine and Health, Division of General Internal Medicine, Mayo Clinic Florida, Jacksonville, FL, USA.
| | - Kasey R Boehmer
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA
| | - Nathan Shippee
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - Stacey A Rizza
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | - Adam I Perlman
- Integrative Medicine and Health, Division of General Internal Medicine, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Sara R Dick
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA
| | - Emma M Behnken
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA
| | - Victor M Montori
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
43
|
Allen K, Damery SL, Sein K, Johnson DW, Davies SJ, Lambie M, Holvoet E, Combes GM. How do patients and their family members experience the transition from peritoneal dialysis to incentre haemodialysis? A multisite qualitative study in England and Australia. Perit Dial Int 2020; 42:297-304. [PMID: 33331224 DOI: 10.1177/0896860820975596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND While numerous studies have explored the patient experience of dialysis or other end-stage kidney disease (ESKD) treatments, few have explored the process of transitioning between dialysis modalities. This study aimed to develop an in-depth understanding of patient and caregiver perceptions and experiences of the transition from peritoneal to haemodialysis (HD) and to identify ways in which transitions can be optimised. METHODS Fifty-four in-depth, semi-structured interviews were undertaken at six study sites across the West Midlands, UK (n = 23), and Queensland, Australia (n = 31). Thirty-nine participants were patients with ESKD; the remainder were family members. An inductive analytical approach was employed, with findings synthesised across sites to identify themes that transcended country differences. RESULTS Of the 39 patient transitions, only 4 patients reported a wholly negative transition experience. Three cross-cutting themes identified common transition experiences and areas perceived to make a difference to the treatment transition: resistance to change and fear of HD; transition experience shared with family; and bodily adjustment and sense of self. CONCLUSION Although each transition is unique to the individual and their circumstances, kidney care services could optimise the process by recognising these patient-led themes and developing strategies that engage with them. Kidney care services should consider ways to keep patients aware of potential future treatment options and present them objectively. There is potential value in integrating expert support before and during treatment transitions to identify and address patient and family concerns.
Collapse
Affiliation(s)
- Kerry Allen
- Health Services Management Centre, University of Birmingham, Edgbaston, UK
| | - Sarah L Damery
- Institute for Applied Health Research, University of Birmingham, Edgbaston, UK
| | - Kim Sein
- Institute for Applied Health Research, University of Birmingham, Edgbaston, UK
| | - David W Johnson
- Department of Nephrology, Division of Medicine, ARTS Building, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Simon J Davies
- Faculty of Medicine and Health Sciences, Keele University, Staffordshire, UK
| | - Mark Lambie
- Faculty of Medicine and Health Sciences, Keele University, Staffordshire, UK
| | - Els Holvoet
- Renal Division, Ghent University Hospital, Belgium
| | - Gill M Combes
- Institute for Applied Health Research, University of Birmingham, Edgbaston, UK
| |
Collapse
|
44
|
Espinoza P, Varela CA, Vargas IE, Ortega G, Silva PA, Boehmer KB, Montori VM. The burden of treatment in people living with type 2 diabetes: A qualitative study of patients and their primary care clinicians. PLoS One 2020; 15:e0241485. [PMID: 33125426 PMCID: PMC7598471 DOI: 10.1371/journal.pone.0241485] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 10/15/2020] [Indexed: 12/02/2022] Open
Abstract
Background The burden of treatment can overwhelm people living with type 2 diabetes and lead to poor treatment fidelity and outcomes. Chronic care programs must consider and mitigate the burden of treatment while supporting patients in achieving their goals. Objective To explore what patients with type 2 diabetes and their health providers consider are the workload and the resources they must mobilize, i.e., their capacity, to shoulder it. Methods We conducted focus groups comprised of 30 patients and 32 clinicians from three community health centers in Chile implementing the Chronic Care Model to reduce cardiovascular risk in patients with type 2 diabetes. Transcripts were analyzed using thematic content analysis techniques illuminated by the Minimally Disruptive Medicine framework. Findings Gaining access to and working with their clinicians, implementing complex medication regimens, and changing lifestyles burdened patients. To deal with the distress of the diagnosis, difficulties achieving disease control, and fear of complications, patients drew capacity from their family (mostly men), social environment (mostly women), lay expertise, and spirituality. Clinicians found that administrative tasks, limited formulary, and protocol rigidity hindered their ability to modify care plans to reduce patient workload and support their capacity. Conclusions Chronic primary care programs burden patients living with type 2 diabetes while hindering clinicians’ ability to reduce treatment workloads or support patient capacity. A collaborative approach toward Minimally Disruptive Medicine may result in treatments that fit the lives and loves of patients and improve outcomes.
Collapse
Affiliation(s)
- Pilar Espinoza
- School of Nursing, Pontificia Universidad Católica de Chile, Santiago, Chile
- * E-mail:
| | - Camila A. Varela
- Mental Community Health Center Pedro Aguirre Cerda, Santiago, Chile
| | - Ivonne E. Vargas
- School of Nursing, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Paulo A. Silva
- School of Nutrition, Universidad San Sebastian, Santiago, Chile
| | - Kasey B. Boehmer
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, New York, United States of America
| | - Victor M. Montori
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, New York, United States of America
| |
Collapse
|
45
|
Oliver BJ, Batalden PB, DiMilia PR, Forcino RC, Foster TC, Nelson EC, Garre BA. COproduction VALUE creation in healthcare service (CO-VALUE): an international multicentre protocol to describe the application of a model of value creation for use in systems of coproduced healthcare services and to evaluate the initial feasibility, utility and acceptability of associated system-level value creation assessment approaches. BMJ Open 2020; 10:e037578. [PMID: 33020095 PMCID: PMC7537448 DOI: 10.1136/bmjopen-2020-037578] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Coproduction introduces a fundamental shift in how healthcare service is conceptualised. The mechanistic idea of healthcare being a 'product' generated by the healthcare system and delivered to patients is replaced by that of a service co-created by the healthcare system and the users of healthcare services. Fjeldstad et al offer an approach for conceptualising value creation in complex service contexts that we believe is applicable to coproduction of healthcare service. We have adapted Fjeldstad's value creation model based on a detailed case study of a renal haemodialysis service in Jonkoping, Sweden, which demonstrates coproduction characteristics and key elements of Fjeldstad's model. METHODS AND ANALYSIS We propose a five-part coproduction value creation model for healthcare service: (1) value chain, characterised by a standardised set of processes that serve a commonly occurring need; (2) value shop, which offers a customised response for unique cases; (3) a facilitated value network, which involves groups of individuals struggling with similar challenges; (4) interconnection between shop, chain and network elements and (5) leadership. We will seek to articulate and assess the value creation model through the work of a community of practice comprised of a diverse international workgroup with representation from executive, financial and clinical leaders as well as other key stakeholders from multiple health systems. We then will conduct pilot studies of a qualitative self-assessment process in participating health systems, and ultimately develop and test quantitative measures for assessing coproduction value creation. ETHICS AND DISSEMINATION This study has been approved by the Dartmouth-Hitchcock Health Institutional Review Board (D-HH IRB) as a minimal risk research study. Findings and scholarship will be disseminated broadly through continuous engagement with health system stakeholders, national and international academic presentations and publications and an internet-based electronic platform for publicly accessible study information.
Collapse
Affiliation(s)
- Brant J Oliver
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Paul B Batalden
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Peter Rocco DiMilia
- Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Rachel C Forcino
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Tina C Foster
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Eugene C Nelson
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | | |
Collapse
|
46
|
Packer T, Kephart G, Audulv Å, Keddy A, Warner G, Peacock K, Sampalli T. Protocol for development, calibration and validation of the Patient-Reported Inventory of Self-Management of Chronic Conditions (PRISM-CC). BMJ Open 2020; 10:e036776. [PMID: 32998919 PMCID: PMC7528366 DOI: 10.1136/bmjopen-2020-036776] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Assessing and measuring patients' chronic condition self-management needs are critical to quality health care and to related research. One in three adults around the world live with multiple chronic conditions. While many patient-reported measures of self-management have been developed, none has emerged as the gold standard, and all have one or more of the following limitations: (1) they fail to measure the different domains of self-management important to patients, (2) they lack sufficient specificity to support patient-centred care or identify the specific components of self-management interventions that work and/or (3) they lack suitability for patients with multiple chronic conditions. METHODS AND ANALYSIS The Patient-Reported Inventory of Self-Management of Chronic Conditions (PRISM-CC) is being developed to overcome these shortcomings. It will measure respondents' perceived success (or difficulty) in self-managing seven domains important to patients. The protocol has three phases. Phase 1 is conceptual model development and item generation. Phase 2 is assessment of the relevance and understanding of items by people with chronic conditions. Phase 3 is item analysis, dimensionality assessment, scaling and preliminary validation of the PRISM-CC using an online survey of people with chronic conditions (n~750). The expected completion date is early 2021. ETHICS AND DISSEMINATION This study will adhere to the Canadian Tri-Council Policy Statement on Ethical Conduct for Research Involving Humans. Ethics approval for all phases has been obtained from the Nova Scotia Health Authority Research Ethics Board. Once completed, the PRISM-CC will be made available for research and healthcare at minimal to no cost.
Collapse
Affiliation(s)
- Tanya Packer
- Schools of Occupational Therapy and Health Administration, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
- Rehabilitation Department, Radboud Unversity Medical Centre, Nijmegen, Gelderland, The Netherlands
| | - George Kephart
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Åsa Audulv
- Department of Nursing, Umeå Universitet Medicinska fakulteten, Umea, Sweden
| | - America Keddy
- School of Occupational Therapy, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Grace Warner
- School of Occupational Therapy, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kylie Peacock
- School of Occupational Therapy, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Tara Sampalli
- Research, Innovation and Discovery, Nova Scotia Health, Halifax, Nova Scotia, Canada
| |
Collapse
|
47
|
Perlman AI, Abu Dabrh AM. Health and Wellness Coaching in Serving the Needs of Today's Patients: A Primer for Healthcare Professionals. Glob Adv Health Med 2020; 9:2164956120959274. [PMID: 33014630 PMCID: PMC7509728 DOI: 10.1177/2164956120959274] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/06/2020] [Accepted: 05/26/2020] [Indexed: 11/17/2022] Open
Abstract
The past six decades have been marked by leaps and bounds in medical advances, while concurrently clinical outcomes and the quality of life continued to lag or decline. There is a need for more comprehensive approaches to delivering healthcare to patients that address illness and wellness within and outside healthcare settings. Mounting evidence shows that making sustainable changes in healthcare requires approaching patients'/individuals' care as a continuum-within and outside healthcare settings-while addressing their capacity (ie ability) and workload (ie demands) and incorporating their values and preferences. Health and Wellness Coaching (HWC) has been proposed as a solution to create partnerships to empower individuals to take ownership, leadership, and accountability of their well-being, using nondirective, empathic, and mindful conversations that employ motivational-interviewing and evidence-based approaches. Insufficient clarity exists among healthcare professionals in understanding the definition, roles, and types of HWC. This primer summarizes HWC concepts and history and compares HWC types and its potential role in promoting, supporting, and improving the well-being, clinical outcomes, and quality of life of the pertinent stakeholders. This primer also highlights current and potential areas of application of HWC within different subpopulations and healthcare-related settings.
Collapse
Affiliation(s)
- Adam I Perlman
- Integrative Medicine and Health, General Internal Medicine, Mayo Clinic Florida, Jacksonville, Florida
| | - Abd Moain Abu Dabrh
- Integrative Medicine and Health, General Internal Medicine, Mayo Clinic Florida, Jacksonville, Florida.,Department of Family Medicine, Mayo Clinic Florida, Jacksonville, Florida
| |
Collapse
|
48
|
Coyne E, Carlini J, Doherty T, Harlow W, Mitchell ML, Grealish L. Partnership between Nurse Navigators and adult persons living with complex chronic disease-An exploratory study. J Clin Nurs 2020; 29:2918-2926. [PMID: 32498116 DOI: 10.1111/jocn.15364] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/29/2020] [Accepted: 05/24/2020] [Indexed: 12/11/2022]
Abstract
AIMS AND OBJECTIVES The aim of this study was to explore nurse navigators and consumers' experience of partnership. BACKGROUND The nurse navigator has recently emerged as an advanced practice role in the care of persons with complex and chronic disease states. Self-care is an important principle in chronic disease models of care, requiring healthcare practitioners to partner with clients in their care. How nurse navigators and consumers [clients and family] experience partnership has not been explored. DESIGN An interpretive exploratory qualitative approach was used. Semi-structured interviews were conducted with seven nurse navigators working with adults with complex disease states and eleven of their clients. Interviews were analysed using descriptive content analysis. (COREQ checklist Data S1). RESULTS Five themes about partnership emerged. Three themes from nurse navigators were as follows: establishing and sustaining relationships, nurse-led planning and aligning care with clients' needs. The two consumer themes were as follows: regular contact means access to the health system and nurse presence is valued. The secondary analysis revealed two themes about partnership between the nurse and consumer: establishing relationships require nursing effort to be established and partnerships are person-focused and nurse-led. CONCLUSIONS Partnership begins with a relationship, largely driven by the nurse navigator through regular communication and personal contact that was valued by consumers. The nurse-led partnership reduced opportunities for consumers to learn to manage their treatments, particularly how and when to access services, meaning that self-care may not be fully achieved. Client navigation occurs over long periods, which could lead to the navigators being overwhelmed, raising an issue of sustainability. RELEVANCE TO CLINICAL PRACTICE Nurse navigators establish a client relationship as a foundation for partnership. This partnership needs a focus on promoting client self-care, self-management of treatment, including when and how to access available services, to ensure the sustainability of the nurse navigator model of care.
Collapse
Affiliation(s)
- Elisabeth Coyne
- School of Nursing, Midwifery, Menzies Health Institute, Griffith University, Brisbane, Australia
| | - Joan Carlini
- Gold Coast Hospital, Southport, Australia.,Department of Marketing, Griffith Business School, Griffith University, Brisbane, Australia
| | | | | | - Marion L Mitchell
- School of Nursing, Midwifery, Menzies Health Institute, Griffith University, Brisbane, Australia.,Princess Alexandra Hospital, Brisbane, Australia
| | - Laurie Grealish
- School of Nursing, Midwifery, Menzies Health Institute, Griffith University, Brisbane, Australia.,Gold Coast Hospital, Southport, Australia
| |
Collapse
|
49
|
Yin K, Jung J, Coiera E, Laranjo L, Blandford A, Khoja A, Tai WT, Phillips DP, Lau AYS. Patient Work and Their Contexts: Scoping Review. J Med Internet Res 2020; 22:e16656. [PMID: 32484449 PMCID: PMC7298639 DOI: 10.2196/16656] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 02/04/2020] [Accepted: 03/29/2020] [Indexed: 12/19/2022] Open
Abstract
Background Having patients self-manage their health conditions is a widely promoted concept, but many patients struggle to practice it effectively. Moreover, few studies have analyzed the nature of work required from patients and how such work fits into the context of their daily life. Objective This study aimed to review the characteristics of patient work in adult patients. Patient work refers to tasks that health conditions impose on patients (eg, taking medications) within a system of contextual factors. Methods A systematic scoping review was conducted using narrative synthesis. Data were extracted from PubMed, Excerpta Medica database (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycINFO, including studies from August 2013 to August 2018. The included studies focused on adult patients and assessed one or more of the following: (1) physical health–related tasks, (2) cognitive health–related tasks, or (3) contextual factors affecting these tasks. Tasks were categorized according to the themes that emerged: (1) if the task is always visible to others or can be cognitive, (2) if the task must be conducted collaboratively or can be conducted alone, and (3) if the task was done with the purpose of creating resources. Contextual factors were grouped according to the level at which they exert influence (micro, meso, or macro) and where they fit in the patient work system (the macroergonomic layer of physical, social, and organizational factors; the mesoergonomic layer of household and community; and the microergonomic triad of person-task-tools). Results In total, 67 publications were included, with 58 original research articles and 9 review articles. A variety of patient work tasks were observed, ranging from physical and tangible tasks (such as taking medications and visiting health care professionals) to psychological and social tasks (such as creating coping strategies). Patient work was affected by a range of contextual factors on the micro, meso, or macro levels. Our results indicate that most patient work was done alone, in private, and often imposing cognitive burden with low amounts of support. Conclusions This review sought to provide insight into the work burden of health management from a patient perspective and how patient context influences such work. For many patients, health-related work is ever present, invisible, and overwhelming. When researchers and clinicians design and implement patient-facing interventions, it is important to understand how the extra work impacts one’s internal state and coping strategy, how such work fits into daily routines, and if these changes could be maintained in the long term.
Collapse
Affiliation(s)
- Kathleen Yin
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Joshua Jung
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Enrico Coiera
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Liliana Laranjo
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Ann Blandford
- UCL Interaction Centre, University College London, London, United Kingdom
| | - Adeel Khoja
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Wan-Tien Tai
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Daniel Psillakis Phillips
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Annie Y S Lau
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia.,UCL Interaction Centre, University College London, London, United Kingdom
| |
Collapse
|
50
|
Banasiak K, Cleary D, Bajurny V, Barbieri P, Nagpal S, Sorensen M, Tabiou N, Witteman H, Senior P. Language Matters - A Diabetes Canada Consensus Statement. Can J Diabetes 2020; 44:370-373. [PMID: 32616274 DOI: 10.1016/j.jcjd.2020.05.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/21/2020] [Indexed: 11/16/2022]
Abstract
Language reflects and shapes our thoughts, feelings, behaviours and experiences and can have a profound impact on the lives of people with and at risk for diabetes. Inappropriate language has a negative impact on self-efficacy, well-being and confidence of people living with diabetes, can seriously undermine experiences with health-care providers and, more broadly, can contribute to diabetes stigma. To date, Diabetes Canada has had no formal position to facilitate positive and affirming attitudes towards diabetes, which is reflected by the use of more appropriate language around diabetes. This consensus statement was developed by Diabetes Canada, by a working group comprised of health-care professionals and lived experience subject matter experts (LESME: patient partners) and validated by volunteers from Diabetes Canada's Professional Section and Diabetes Action Canada's Patient Circles. The principles outlined in this document will be valuable in three broad domains: 1) Diabetes Canada's internal and external communications, 2) increasing public awareness of diabetes and reduction of stigma around diabetes and 3) enhancing the health, wellness and self-efficacy of persons living with diabetes. A major strategy to effect change in this third domain will be to disseminate these concepts broadly among all current (and future) health-care professionals to help integrate positive and supportive attitudes in everyday clinical practice.
Collapse
Affiliation(s)
- Krista Banasiak
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
| | | | | | | | - Seema Nagpal
- Department of Science and Policy, Diabetes Canada, Ottawa, Ontario, Canada
| | | | - Nadia Tabiou
- Department of Science and Policy, Diabetes Canada, Ottawa, Ontario, Canada; Patient Partner, Gatineau, Québec, Canada
| | - Holly Witteman
- Department of Family and Emergency Medicine, Laval University, Québec City, Québec, Canada
| | - Peter Senior
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|