The worse we feel, the more intensively we need to stick together: a qualitative study of couples' emotional co-regulation of the challenge of multimorbidity

Introduction

Being faced with multimorbidity (i.e., being diagnosed with at least two chronic conditions), is not only demanding in terms of following complicated medical regimes and changing health behaviors. The changes and threats involved also provoke emotional responses in the patients but also in their romantic partners. This study aims at exploring the ways of emotional co-regulation that couples facing multimorbidity express when interviewed together.

Method

N = 15 opposite sex couples with one multimorbid patient after an acute health crisis that led to hospitalization were asked in a semi-structured interview about how they found ways to deal with the health situation, what they would recommend to other couples in a similar situation, and how they regulated their emotional responses. Interviews were analyzed qualitatively following open, axial, and selective coding, as in the grounded theory framework.

Results

Emerging categories from the romantic partners' and the patients' utterances revealed three main categories: First, overlapping cognitive appraisals about the situation (from fighting spirit to fatalism) and we-ness (construing the couple self as a unit) emerged as higher order factor from the utterances. Second, relationship-related strategies including strategies aimed at maintaining high relationship quality in spite of the asymmetric situation like strengthening the common ground and balancing autonomy and equity in the couple were often mentioned. Third, some couples mentioned how they benefit from individual strategies that involve fostering individual resources of the partners outside the couple relationship (such as cultivating relationships with grandchildren or going outdoors to nature).

Discussion

Results underline the importance of a dyadic perspective not only on coping with disease but also on regulating the emotional responses to this shared challenging situation. The utterances of the couples were in line with earlier conceptualizations of interpersonal emotion regulation and dyadic perspectives on we-disease. They broaden the view by integrating the interplay between individual and interpersonal regulation strategies and underline the importance of balancing individual and relational resources when supporting couples faced with chronic diseases.

Coping Strategies Preferred by Patients Treated for Osteoporosis and Analysis of the Difficulties Resulting from the Disease

Osteoporosis has been recognized as a civilization disease. This chronic condition needs a long-term management plan with a holistic approach to patients. The specificity of the patient’s response to the disease and coping strategies are very important in the treatment process. The aim of this research was to analyze the strategies of coping with disease preferred by patients treated for osteoporosis, and to determine the relationship between the self-assessment of patients’ health, time of treatment, sociodemographic variables, and strategies of coping with a chronic disease such as osteoporosis. The study was conducted from August 2016 to July 2018 at an osteoporosis clinic in eastern Poland. Coping Orientations to Problems Experienced (COPE) by C.S. Carver, M. F. Scheier, and J. K. Weintraub in the Polish adaptation and our own questionnaire were used. The study participants were 312 patients treated for osteoporosis. The respondents treated in the osteoporosis clinic used the strategies of seeking support and focusing on emotions to the greatest extent, and avoidance strategies the least. Sociodemographic features and self-assessment of health condition significantly differentiate the strategies of coping with the disease. The analysis showed that the higher the assessment of the individual perception of one’s own health, the more often the respondents used active coping strategies.

Medication Adherence and Coping with Disease in Patients from a Neurological Clinic: An Observational Study

PURPOSE

Medication non-adherence is a huge concern for the medical community. For chronic, especially neurological diseases, taking medication is a central pillar of treatment. To improve adherence to these oftentimes complex medication regimens, the construct needs to be understood in more depth. The aim of this study was to investigate associations between adherence with sociodemographics, clinical variables, and coping in neurological patients.

PATIENTS AND METHODS

The sample consisted of 545 patients from a German neurological clinic. Adherence was assessed with the Stendal Adherence to Medication Score (SAMS). Patients were grouped as completely adherent (SAMS = 0), non-adherent (upper 25% of the sample), and moderately adherent. Associations with coping were assessed using the Essen Coping Questionnaire.

RESULTS

Medication adherence was low compared to other non-neurological patient samples. Differences between adherence groups were found regarding gender and facets of coping, namely "trivialisation, wishful thinking and defence" and "finding of inner stability".

CONCLUSION

Interventions to improve medication adherence should focus on facets of coping with disease, increasing acceptance of disease, willpower, and confidence in treatment.

Sickle cell disease perceptions of caregivers, adolescent, and adult patients: Barriers and facilitators to medical care adherence

AIMS

To provide an understanding of medical care adherence factors as reported by caregivers, adolescent, and adult patients with sickle cell disease and to analyse those concerns to identify barriers and facilitators about medical care adherence. Three topics influenced medical care adherence: the disease itself, therapeutics, and the healthcare system. This study will focus on the first topic.

DESIGN

Qualitative explorative study, using semi-structured and life-experience interviews and manual inductive content analysis.

METHODS

From December 2016 - March 2017, one semi-structured interview was conducted by a researcher with each of the 15 adolescent patients, 10 adult patients, and 19 caregivers in a French public hospital. Interviews were audio-taped and transcribed before a content analysis. Perceptions were classified into barriers and facilitators of medical care adherence.

RESULTS

This article presents disease perceptions of caregivers and patients (adolescents and adults): daily management and social representations. These perceptions differ among parents, adolescent patients, and adult patients. However, all report important disease-related "limitations" in their lives. The objective for adults (parents and patients) is to "live with the disease" and to achieve this, they find coping resources. Two major resources expressed by adults emerged: social resources (support from friends, patients' association, and social visibility) and disease knowledge (theoretical and derived from experience). This is not the case of adolescents for whom social normality was the main concern.

CONCLUSION

Care management adherence is partly based on coping with the disease. Given the lower number of facilitators expressed by adolescents, it is essential to propose interventions in this population. It will help them cope with the disease and, consequently, optimize care management adherence.

IMPACT

Showing differences among caregivers, adult, and adolescent patient perceptions, this study impact future care practices. It revealed needs of intervention for adolescents.