A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

Abstract

BackgroundDespite robust evidence concerning self-management for some long-term conditions (LTCs), others lack research explicitly on self-management and, consequently, some patient groups may be overlooked.AimTo undertake a rapid, systematic overview of the evidence on self-management support for LTCs to inform health-care commissioners and providers about what works, for whom, and in what contexts.MethodsSelf-management is ‘the tasks . . . individuals must undertake to live with one or more chronic conditions . . . [including] . . . having the confidence to deal with medical management, role management and emotional management of their conditions’. We convened an expert workshop and identified characteristics of LTCs potentially of relevance to self-management and 14 diverse exemplar LTCs (stroke, asthma, type 2 diabetes mellitus, depression, chronic obstructive pulmonary disease, chronic kidney disease, dementia, epilepsy, hypertension, inflammatory arthropathies, irritable bowel syndrome, low back pain, progressive neurological disorders and type 1 diabetes mellitus). For each LTC we conducted systematic overviews of systematic reviews of randomised controlled trials (RCTs) of self-management support interventions (‘quantitative meta-reviews’); and systematic overviews of systematic reviews of qualitative studies of patients’ experiences relating to self-management (‘qualitative meta-reviews’). We also conducted an original systematic review of implementation studies of self-management support in the LTCs. We synthesised all our data considering the different characteristics of LTCs. In parallel, we developed a taxonomy of the potential components of self-management support.ResultsWe included 30 qualitative systematic reviews (including 515 unique studies), 102 quantitative systematic reviews (including 969 RCTs), and 61 studies in the implementation systematic review. Effective self-management support interventions are multifaceted, should be tailored to the individual, their culture and beliefs, a specific LTC and position on the disease trajectory, and underpinned by a collaborative/communicative relationship between the patient and health-care professional (HCP) within the context of a health-care organisation that actively promotes self-management. Self-management support is a complex intervention and although many components were described and trialled in the studies no single component stood out as more important than any other. Core components include (1) provision of education about the LTC, recognising the importance of understanding patients’ pre-existing knowledge and beliefs about their LTC; (2) psychological strategies to support adjustment to life with a LTC; (3) strategies specifically to support adherence to treatments; (4) practical support tailored to the specific LTC, including support around activities of daily living for disabling conditions, action plans in conditions subject to marked exacerbations, intensive disease-specific training to enable self-management of specific clinical tasks; and (5) social support as appropriate. Implementation requires a whole-systems approach which intervenes at the level of the patient, the HCP and the organisation. The health-care organisation is responsible for providing the means (both training and time/material resources) to enable HCPs to implement, and patients to benefit from, self-management support, regularly evaluating self-management processes and clinical outcomes. More widely there is a societal need to address public understanding of LTCs. The lack of public story for many conditions impacted on patient help-seeking behaviour and public perceptions of need.ConclusionsSupporting self-management is inseparable from the high-quality care for LTCs. Commissioners and health-care providers should promote a culture of actively supporting self-management as a normal, expected, monitored and rewarded aspect of care. Further research is needed to understand how health service managers and staff can achieve this culture change in their health-care organisations.Study registrationThis study is registered as PROSPERO CRD42012002898.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

Barriers to self-management of chronic pain in primary care: a qualitative focus group study

“…39 The findings of the current study concur with much of this earlier work. Taylor and colleagues 40 rapid synthesis of self-management support for all long-term conditions explored what works, for whom, and in what contexts. They identified a need for a culture of actively supporting self-management as a normal, expected aspect of the provision of care; the need for tailoring to the individual, their culture and beliefs, and the time point in the condition; the need for good communication between patient and HCP; information and education; support with psychological impact of long-term conditions; and implementing a whole-systems approach to self-management support.…”

Cancer survivors’ perspectives on adjustment-focused self-management interventions: a qualitative meta-synthesis

“…Indeed, our findings provide further evidence for the limitations of 7 a 'one size fits all' approach to self-management support [10,40,41], and demonstrate the need for tailoring the 8 design, content and delivery of self-management interventions to the needs and preferences of specific groups of 9 cancer survivors in order to optimise their 'reach'. Firstly, although participants' views on the value of sharing 10 their experiences with fellow cancer survivors lends further support to the benefits of peer support in this cohort 11 [42,43], perceived similarity with others (e.g., in terms of age or time since diagnosis) was a key influence on the 12 acceptability of group-based interventions.…”

Posttraumatic stress disorder following asthma attack: the role of agency beliefs in mediating psychiatric morbidity

“…Systematic reviews on psychological interventions for asthma found that these methods may be effective, but were inconclusive due to small sample sizes and differing outcome measures (see Smith & Jones, 2015;Yorke et al, 2007). Future studies on interventions should more explicitly incorporate efficacy building and longitudinally measure changes in self-efficacy to further support the importance of self-efficacy for people with asthma, PTSD, and co-morbid disorders (Battersby et al, 2010;Marks et al, 2005;Taylor et al, 2014).…”

“…A central aspect of self-management in chronic illness is 'perceived control'. Decreased perceived control is common in people with asthma and is associated 5 with health outcomes (Adams et al, 2004), and both Marks et al (2005) and Taylor et al (2014) suggest an important aim of self-management of chronic illness is to enhance the agency/control construct 'self-efficacy'.…”

“…(Pinnock, 2015;Taylor et al, 2014). A central aspect of self-management in chronic illness is 'perceived control'.…”