Minimally disruptive medicine: the evidence and conceptual progress supporting a new era of healthcare

Dabrh, Abd Moain Abu; Gallacher, Katie; Boehmer, Kasey R.; Hargraves, Ian; Mair, Frances S

doi:10.4997/jrcpe.2015.205

Cited by 42 publications

(58 citation statements)

References 27 publications

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“…When patients are noncompliant, this may be interpreted as a capacity–workload imbalance. A patient’s capacity may not be sufficient to manage the treatment workload, thus creating a burden 33. Rather than labeling patients as noncompliant, we may need to reassess the patient’s workload and capacity before commencing new treatments.…”

Section: Discussionmentioning

confidence: 99%

Patient-perceived treatment burden of chronic obstructive pulmonary disease

Harb

Foster

Dobler

2017

COPD

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BackgroundWhile chronic morbidity and mortality from COPD is well documented, little is known about the treatment burden faced by patients with COPD.Subjects and methodsPatients with severe airflow obstruction (forced expiratory volume in 1 second [FEV1] <50% predicted) representing different age-groups, sex, and number of comorbidities participated in a semistructured interview. Interviews were conducted until thematic saturation was reached. Interviews were recorded, transcribed, and analyzed thematically using an established treatment-burden framework.ResultsA total of 26 patients (42% male, mean age 66.7±9.8 years) with severe (n=15) or very severe (n=11) airflow limitation (mean FEV1 32.1%±9.65% predicted) were interviewed. Participants struggled with various treatment-burden domains, predominantly with changing health behaviors, such as smoking cessation and exercise. Interviewees often only ceased smoking after a major health event, despite being advised to do so earlier by a doctor. Recommended exercise regimens, such as pulmonary rehabilitation classes, were curtailed, although some patients replaced them with light home-based exercise. Interviewees had difficulty attending medical appointments, often relying on others to transport them. Overall, COPD patients indicated they were not willing to accept the burden of treatments where they perceived minimal benefit.ConclusionThis study describes the substantial treatment burden experienced by patients with COPD. Medical advice may be rejected by patients if the benefit of following the advice is perceived as insufficient. Health professionals need to recognize treatment burden as a source of nonadherence, and should tailor treatment discussions to fit patients’ values and capacity to achieve optimal patient outcomes.

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Section: Discussionmentioning

confidence: 99%

Patient-perceived treatment burden of chronic obstructive pulmonary disease

Harb

Foster

Dobler

2017

COPD

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“…Patients with multiple chronic conditions and their caregivers may face challenges in meeting the demands of both self-care and healthcare. Characterizing the role that capacity plays in this effort has become an important area of investigation [2–5]. Insights to date suggest that a key and distinguishing aspect of capacity is that it is distributed amongst many life activities and linked to the social networks of patients.…”

Section: Introductionmentioning

confidence: 99%

Patient capacity and constraints in the experience of chronic disease: a qualitative systematic review and thematic synthesis

et al. 2016

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BackgroundLife and healthcare demand work from patients, more so from patients living with multimorbidity. Patients must respond by mobilizing available abilities and resources, their so-called capacity. We sought to summarize accounts of challenges that reduce patient capacity to access or use healthcare or to enact self-care while carrying out their lives.MethodsWe conducted a systematic review and synthesis of the qualitative literature published since 2000 identifying from MEDLINE, EMBASE, Psychinfo, and CINAHL and retrieving selected abstracts for full text assessment for inclusion. After assessing their methodological rigor, we coded their results using a thematic synthesis approach.ResultsThe 110 reports selected, when synthesized, showed that patient capacity is an accomplishment of interaction with (1) the process of rewriting their biographies and making meaningful lives in the face of chronic condition(s); (2) the mobilization of resources; (3) healthcare and self-care tasks, particularly, the cognitive, emotional, and experiential results of accomplishing these tasks despite competing priorities; (4) their social networks; and (5) their environment, particularly when they encountered kindness or empathy about their condition and a feasible treatment plan.ConclusionPatient capacity is a complex and dynamic construct that exceeds “resources” alone. Additional work needs to translate this emerging theory into useful practice for which we propose a clinical mnemonic (BREWS) and the ICAN Discussion Aid.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-016-0525-9) contains supplementary material, which is available to authorized users.

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“…Although the ideals underpinning this redistribution of responsibility are founded upon the promotion and encouragement of self‐care, accountability, self‐empowerment and self‐actualisation, new demands are placed upon ill people that may manifest in treatment burden (May et al., ). Treatment burden refers to the multidimensional work that consumers must perform to adhere to recommendations made by their clinicians to manage illness and well‐being (Abu Dabrh, Gallacher, Boehmer, Hargraves, & Mair, ; Mair & May, ; May et al., ). If the workload is high, or if consumers and their relational networks do not have the capacity to manage this work, it becomes challenging for them to participate in activities known to improve quality of life (Doherty & Gaughran, ; May, Montori, & Mair, ; Shippee, Shah, May, Mair, & Montori, ).…”

Section: Introductionmentioning

confidence: 99%

Making sense of self‐care practices at the intersection of severe mental illness and physical health—An Australian study

Ehrlich

Chester

Kisely

et al. 2017

Health Soc Care Community

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The poor physical health of people who experience severe mental illness (SMI) is an important public health issue that has been acknowledged, yet not properly addressed.People who live with SMI perform a myriad of complex tasks in order to take care of their physical health, while receiving unpredictable levels of support and assistance from health professionals. In this qualitative study, we aimed to uncover the kinds of work people with SMI do in order to look after their physical health. In a metropolitan area in Queensland, Australia, 32 people with lived experience of SMI participated in semi-structured, face-to-face interviews. Data were digitally recorded, transcribed verbatim and open coded. They were then themed using a constant comparative process. We found that people with SMI were engaged in a "rhythm of life with illness" that consisted of relatively short, acute and chaotic cycles of mental and physical illness, accompanied by much longer mental and physical illness recovery cycles.Participants engaged in three specific types of health-related work to manage these cycles: discovery work (and the associated role of the health professional); sensemaking work to meaningfully interpret health and illness; and embedding work to become engaged self-managers of illness and producers of health. We discuss how varying levels of support from health professionals impact consumers' self-management of their physical and mental health; how health professionals influence consumers' experience of treatment burden; and implications for practice.

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Minimally disruptive medicine: the evidence and conceptual progress supporting a new era of healthcare

Cited by 42 publications

References 27 publications

Patient-perceived treatment burden of chronic obstructive pulmonary disease

Patient-perceived treatment burden of chronic obstructive pulmonary disease

Patient capacity and constraints in the experience of chronic disease: a qualitative systematic review and thematic synthesis

Making sense of self‐care practices at the intersection of severe mental illness and physical health—An Australian study

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