Morris Rebecca L, Sanders Caroline, Kennedy Anne P, Rogers Anne
National Primary Care Research and Development Centre, University of Manchester, 5th Floor Williamson Building, Manchester, UK.
Chronic Illn. 2011 Jun;7(2):147-61. doi: 10.1177/1742395310393365. Epub 2011 Feb 22.
To examine what influences self-management priorities for individuals with multiple long-term conditions and how this changes over time.
A longitudinal qualitative study using semi-structured interviews completed with 21 participants with more than one chronic condition.
The study demonstrates the impact of multiple conditions on many aspects of people's illness management. Narratives illuminated how individual's condition priorities changed at pivotal points and altered their engagement with self-management practices. This is influenced by contact with health professionals and how people framed illness and lifestyle changes. Medication management was a central point where individuals took control of their conditions. Additional conditions were more readily accommodated if people established a cognitive link between existing management practices. Thus, multiple conditions were not inevitably experienced as an increasing burden but subject to considerable flux and change.
Prioritizing one condition over another at a particular time together with a transfer and amalgamation of practices appears to facilitate accommodation of multiple conditions and ease the burden of everyday management. These findings have implications for how we understand the variable nature of multimorbidity experience and management for patients. Clinicians might usefully engage with patients' understanding to reduce complexity, and enhance engagement of condition management.
探讨哪些因素会影响患有多种长期疾病的个体的自我管理优先级，以及这如何随时间变化。
一项纵向定性研究，对21名患有多种慢性病的参与者进行了半结构化访谈。
该研究证明了多种疾病对人们疾病管理诸多方面的影响。访谈揭示了个体的疾病优先级在关键时刻如何变化，并改变了他们参与自我管理实践的程度。这受到与医疗专业人员接触的影响，以及人们对疾病和生活方式改变的认知方式。药物管理是个体掌控自身病情的核心要点。如果人们在现有的管理实践之间建立起认知联系，那么额外的疾病就更容易得到应对。因此，多种疾病并不必然被视为日益加重的负担，而是会经历相当大的波动和变化。
在特定时间优先处理一种疾病，同时转移和整合管理方法，似乎有助于应对多种疾病，并减轻日常管理的负担。这些发现对于我们如何理解多病共存经历的可变性质以及患者管理具有启示意义。临床医生可以通过了解患者的认知来减少复杂性，并增强疾病管理的参与度。
