Meaningful conversations in living with and treating chronic conditions: development of the ICAN discussion aid

Abstract

BackgroundThe needs of the growing population of complex patients with multiple chronic conditions calls for a different approach to care. Clinical teams need to acknowledge, respect, and support the work that patients do and the capacity they mobilize to enact this work, and to adapt and self-manage. Tools that enable this approach to care are needed.MethodsUsing user-centered design principles, we set out to create a discussion aid for use by patients, clinicians, and other health professionals during clinical encounters. We observed clinical encounters, visited patient homes, and dialogued with patient support groups. We then developed and tested prototypes in routine clinical practice. Then we refined a final prototype with extensive stakeholder feedback.ResultsFrom this process resulted the ICAN Discussion Aid, a tool completed by the patient and reviewed during the consultation in which patients classified domains that contribute to capacity as sources of burden or satisfaction; clinical demands were also classified as sources of help or burden. The clinical review facilitated by ICAN generates hypotheses regarding why some treatment plans may be problematic and may not be enacted in the patient’s situation.ConclusionWe successfully created a discussion aid to elucidate and share insights about the capacity patients have to enact the treatment plan and hypotheses as to why this plan may or may not be enacted. Next steps involve the evaluation of the impact of the ICAN Discussion Aid on clinical encounters with a variety of health professionals and the impact of ICAN-informed treatment plans on patient-important outcomes.

Changing conversations in primary care for patients living with chronic conditions: pilot and feasibility study of the ICAN Discussion Aid

“…The ICAN Discussion Aid (figure 1) was developed to address these problems, with the aim of enabling the discussion of patient workload, capacity and treatment burden within the time constraints of busy primary care visits 17. The process to develop ICAN is described in full elsewhere 17.…”

“…The ICAN Discussion Aid (figure 1) was developed to address these problems, with the aim of enabling the discussion of patient workload, capacity and treatment burden within the time constraints of busy primary care visits 17. The process to develop ICAN is described in full elsewhere 17. Briefly, it was developed using a robust, iterative, user-centred design process, previously used to develop decision aids18 and was grounded in the Cumulative Complexity Model, which states that patients living with chronic illness must enact both patient and life work with limited capacity 19.…”

Benefits and harms of intensive glycemic control in patients with type 2 diabetes

“…SDM is a process for clinicians, patients, and caregivers to partner in the development of the most appropriate and feasible therapeutic plan at a given time based on expert input from both the clinician (grounded in the best available scientific evidence) and the patient/caregiver (providing expertise in the patient’s goals, preferences, and context of care) 132. SDM is facilitated by decision aids for diabetes management,133 conversational elicitation of the patient’s goals/preferences,134 and/or integrated, holistic clinical decision support tools 135136137. Use of decision aids, in particular, allows therapeutic goals and treatment options to be discussed and considered in the context of the patient’s preferences.…”

Minimally disruptive medicine for patients with complex multimorbidity

“…8 The Instrument for Patient Capacity Assessment (ICAN) discussion aid was designed to help clinicians and patients assess the burden of treatment and patients' capacity within the clinical encounter (Figure 2). 18 The clinician component suggests three questions that could be helpful in shifting discussions towards the broader life of the patient and to identify workload and capacity issues. The questions are:…”