Self-management priority setting and decision-making in adults with multimorbidity: A narrative review of literature

Abstract

Objectives The purpose of this narrative review was to synthesize current research findings related to self-management, in order to better understand the processes of priority setting and decision-making in among adults with multimorbidity. Design A narrative literature review was undertaken, synthesizing findings from published, peer-reviewed empirical studies that addressed priority setting and/or decision-making in self-management of multimorbidity. Data sources A search of PubMed, PsychINFO, CINAHL and SocIndex databases was conducted from database inception through December 2013. References lists from selected empirical studies and systematic reviews were evaluated to identify any additional relevant articles. Review methods Full text of potentially eligible articles were reviewed and selected for inclusion if they described empirical studies that addressed priority setting or decision-making in self-management of multimorbidity among adults. Two independent reviewers read each selected article and extracted relevant data to an evidence table. Processes and factors and processes of multimorbidity self-management were identified and sorted into categories of priority setting, decision-making, and facilitators/barriers. Results Thirteen articles were selected for inclusion; most were qualitative studies describing processes, facilitators, and barriers of multimorbidity self-management. The findings revealed that patients prioritize a dominant chronic illness and re-prioritize over time as conditions and treatments change; that multiple facilitators (e.g. support programs) and barriers (e.g. lack of financial resources) impact individuals’ self-management priority setting and decision-making ability; as do individual beliefs, preferences, and attitudes (e.g., perceived personal control, preferences regarding treatment). Conclusions Health care providers need to be cognizant that individuals with multimorbidity engage in day-to-day priority setting and decision-making among their multiple chronic illnesses and respective treatments. Researchers need to develop and test interventions that support day-to-day priority setting and decision-making and improve health outcomes for individuals with multimorbidity.

Nurses' consultative role to health promotion in patients with chronic diseases

“…[12] They contribute to 60% of global mortality and this will reach to 80% in 2020. [3] Frequent hospitalization, use of health services, taking multiple medications, and reduction of the autonomy are among the problems of patients with chronic diseases.…”

Understanding self-management behaviors in symptomatic adults with uncertain etiology using an illness perceptions framework

“…Other work shows that individuals engage in these behaviors— seeking an explanation or diagnosis —in order to more clearly understand what to expect for the future and how to manage a health concern (Koopman & Schweitzer, 1999; Lewis, Skirton, & Jones, 2010). Although individuals’ beliefs about their illness (such as those concerning the severity of the illness and its impact on daily life) have been found to contribute to self-management behaviors across a variety of populations (Bratzke et al, 2015), individuals who cannot identify an explanation, diagnosis, or appropriate treatment options for their condition are likely to experience increased levels of frustration and uncertainty as a result (Nettleton et al, 2005), and we hypothesize that they may also rely more heavily on their beliefs about their illness because they lack the information they need for self-management.…”

Is Australian primary care practice equipped to provide multimorbidity care?

“…Looking to simplify the complexity of managing multiple chronic conditions and the resulting treatment burdens, patients must frequently prioritise conditions, goals, medications and/or outcomes (28,73,93,133,135,189,196,206,(217)(218)(219)(220)(221)(222)(223).…”

“…A critical challenge to emerge from the multimorbidity literature is the need to acknowledge and incorporate patient preferences for care, particularly in relation to determining treatment and management priorities (28,73,93,133,135,189,196,(217)(218)(219)(220)(221)(222)(223). Individuals with multiple conditions are tasked with managing complex treatment regimens, complicated by conflicting conditions, medications, treatments and outcomes (201).…”

“…Individuals with multiple conditions are tasked with managing complex treatment regimens, complicated by conflicting conditions, medications, treatments and outcomes (201). To reduce treatment complexity and minimise negative interactions whether the condition could be controlled by medication; whether the condition disrupted others; and the perceived severity of the condition and its impact on daily life (221). However, Bratzke and colleagues (221) also noted variability across the reviewed studies in how patients' perceived or determined condition severity and impact on daily life.…”