Smyth Rachel C, Smith Georgia, Alexander Emily, May Carl R, Mair Frances S, Gallacher Katie I
University of Glasgow, Glasgow, UK.
London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK.
J Multimorb Comorb. 2025 May 9;15:26335565251314828. doi: 10.1177/26335565251314828. eCollection 2025 Jan-Dec.
Treatment burden describes the workload undertaken by people with chronic illness and multimorbidity to manage their healthcare demands and the impact on their wellbeing. Burden of Treatment Theory (BOTT) describes the work that people with multimorbidity do to self-manage chronic illness/multimorbidity and the factors that affect capacity (personal and healthcare resources, support network) to meet treatment demands. Here we aim to identify and characterise the different applications of Burden of Treatment Theory in research; to explore the contribution of Burden of Treatment Theory to advancing knowledge and understanding of treatment burden and capacity issues and to identify critiques or limitations of Burden of Treatment Theory in research.
Systematic review of BOTT research published in the English language. Databases searched were Web of Science, Scopus, Medline, CINAHL and medRxiv.org. We also consulted with experts in the field. Two reviewers screened titles, abstracts and papers and undertook data extraction. Quality appraisal was undertaken using adapted CASP checklists for qualitative studies and systematic reviews and a Mixed Studies Review checklist.
Thirty papers included: 16 qualitative studies; 5 systematic reviews; 3 protocols; 3 discussion papers, a theory conceptual paper, a realist review and a feasibility trial. Most (n=17) originated in UK, with 3 from Australia and Argentina, 2 from Norway and one each from United States and Malawi. Nine papers mentioned use of BOTT constructs but 21 additionally provided rationale for BOTT use and demonstrated engagement with the theory. Two papers adapted/refined BOTT to the context of their research focus. Twenty-seven studies prospectively outlined use of BOTT, with only 3 applying BOTT retrospectively to report study outputs and 'inform analysis' of findings.
BOTT provides a useful conceptual, analytical and sensitising lens in studies focusing on both the characterisation and alleviation of treatment burden through healthcare interventions, and the constructs discussed are stable and applicable across multiple settings. Future research could include use by empirical researchers in contexts needing more adaptation and critical assessment.
治疗负担描述了慢性病和多种疾病患者为应对其医疗保健需求所承担的工作量以及对其幸福感的影响。治疗负担理论（BOTT）描述了患有多种疾病的人自我管理慢性病/多种疾病所做的工作以及影响满足治疗需求能力（个人和医疗资源、支持网络）的因素。在此，我们旨在识别和描述治疗负担理论在研究中的不同应用；探讨治疗负担理论对推进治疗负担和能力问题的知识和理解的贡献，并识别治疗负担理论在研究中的批评或局限性。
对以英语发表的BOTT研究进行系统综述。检索的数据库有科学网、Scopus、Medline、CINAHL和medRxiv.org。我们还咨询了该领域的专家。两名评审员筛选标题、摘要和论文并进行数据提取。使用适用于定性研究和系统综述的改编CASP清单以及混合研究综述清单进行质量评估。
纳入30篇论文：16篇定性研究；5篇系统综述；3篇方案；3篇讨论论文、1篇理论概念论文、1篇现实主义综述和1项可行性试验。大多数（n = 17）起源于英国，3篇来自澳大利亚和阿根廷，2篇来自挪威，1篇分别来自美国和马拉维。9篇论文提到使用了BOTT结构，但另外21篇提供了使用BOTT的理由并展示了与该理论的结合。两篇论文根据其研究重点的背景对BOTT进行了改编/完善。27项研究前瞻性地概述了BOTT的使用，只有3项回顾性地应用BOTT来报告研究结果并“为结果分析提供信息”。
BOTT为关注通过医疗干预来描述和减轻治疗负担的研究提供了一个有用的概念、分析和敏感视角，所讨论的结构稳定且适用于多种环境。未来的研究可能包括实证研究人员在需要更多调整和批判性评估的背景下使用该理论。
