Shenzhen Nanshan People's Hospital, Shenzhen, China.
Tenth People's Hospital of Tongji University, China.
Eur J Cardiovasc Nurs. 2019 Dec;18(8):700-710. doi: 10.1177/1474515119863178. Epub 2019 Jul 18.
Priority setting and decision-making in relation to self-management of multiple conditions is particularly challenging for both patients and health professionals. The aim of this study was to validate a conceptual model of self-management priority setting and decision-making in multimorbidity and confirm factors that influence self-management prioritizing and decision-making in a sample of patients with acute coronary syndrome and type 2 diabetes mellitus.
This was a qualitative study using deductive directed content analysis. A purposive sample of 21 participants with acute coronary syndrome and type 2 diabetes mellitus that were admitted to a Shanghai hospital were interviewed.
Participants provided evidence to confirm all but one of the factors from the conceptual model. Internal factors influencing self-management predominated. Agreement with recommended treatment, functional capacity and perceived synergies, antagonistic effects, or interactions among the conditions and prescribed treatments, was emphasized. The facilitators and barriers to priority setting and decision-making were related to available resources, provider communication and, to a lesser extent, confusion about recommendations, and treatment complexity. Some participants were also concerned about treatment side effects.
Internal factors (personal beliefs, preferences, and attitudes) and facilitators and barriers (knowledge, finances, social support, and transportation) were related to changes in priority setting and decision-making and self-management behavior in this sample. Health education, which includes case studies with shifting self-management priorities is recommended, rather than a unique disease-specific focus. Further research, exploring the relationship between these factors and changes in the dominant condition and related management, using valid and reliable instruments that capture these key factors, is recommended.
多种疾病的自我管理优先级设定和决策对患者和卫生专业人员来说都是极具挑战性的。本研究旨在验证一种多病症自我管理优先级设定和决策的概念模型，并确认影响急性冠脉综合征和 2 型糖尿病患者自我管理优先级设定和决策的因素。
这是一项使用演绎定向内容分析的定性研究。我们对 21 名患有急性冠脉综合征和 2 型糖尿病并入住上海某医院的患者进行了目的抽样访谈。
参与者提供的证据证实了概念模型中除一个因素外的所有因素。内部因素对自我管理的影响占主导地位。强调了对推荐治疗的认同、功能能力以及对疾病和规定治疗之间的协同作用、拮抗作用或相互作用的感知。优先级设定和决策的促进因素和障碍与可用资源、提供者沟通以及在较小程度上与推荐意见和治疗复杂性有关。一些参与者还担心治疗的副作用。
本研究样本中，内部因素（个人信念、偏好和态度）以及促进因素和障碍（知识、财务、社会支持和交通）与优先级设定和决策以及自我管理行为的变化有关。建议开展健康教育，包括具有改变自我管理优先级的案例研究，而不是单一的针对特定疾病的教育。建议使用能够捕捉这些关键因素的有效且可靠的工具，进一步研究这些因素与主要疾病及相关管理的变化之间的关系。
