To characterize diseases that are described as most bothersome by individuals with multiple chronic conditions and to identify themes that characterize their experiences with their most bothersome condition.
Methods
In a survey of patients at an academic center and a Veterans Affairs hospital, we asked individuals with multiple chronic conditions to identify their most bothersome chronic condition and describe why it is challenging. Standard content analysis methods were used to code responses and identify themes reflecting characteristics of most bothersome conditions.
Results
The most commonly cited bothersome conditions were chronic pain (52%), diabetes (43%), post-traumatic stress disorder (25%), heart failure (24%), and lung problems (20%). Conditions were described as most bothersome due to: (a) impact on function and quality of life (e.g. active symptoms, activity limitations), (b) health consequences or sequelae (e.g. risk of complications), and (c) challenges associated with treatment or self-management. Patterns of theme dominance varied for conditions with different characteristics.
Discussion
The conditions that patients with multiple chronic conditions identify as most bothersome vary depending on individuals’ diseases and their health-related preferences and priorities. Ascertaining patients’ most bothersome conditions and associated challenges, stress, and frustrations may help ensure that management decisions are aligned with patient preferences and priorities.
WardBSchillerJGoodmanR. Multiple chronic conditions among US adults: a 2012 update. Prev Chronic Dis2014; 11: 130389–130389.
2.
Centers for Medicare & Medicaid Services, Baltimore MD. Chronic conditions among medicare beneficiaries, Chartbook. 2012.
3.
GoodmanRAPosnerSFHuangESet al.Defining and measuring chronic conditions: imperatives for research, policy, program, and practice. Prev Chronic Dis2013; 10: E66. 120239–E66. 120239.
4.
BaylissEASteinerJFFernaldDHet al.Descriptions of barriers to self-care by persons with comorbid chronic diseases. Ann Fam Med2003; 1: 15–21.
5.
HaverhalsLMLeeCASiekKAet al.Older adults with multi-morbidity: medication management processes and design implications for personal health applications. J Med Internet Res2011; 13: e44–e44.
6.
DicksonVVBuckHRiegelB. A qualitative meta-analysis of heart failure self-care practices among individuals with multiple comorbid conditions. J Card Fail2011; 17: 413–419.
7.
NoelPHParchmanMLWilliamsJWJr.et al.The challenges of multimorbidity from the patient perspective. J Gen Intern Med2007; 22(Suppl 3): 419–424.
8.
SchoenbergNELeachCEdwardsW. “It's a toss up between my hearing, my heart, and my hip”: Prioritizing and accomodating multiple morbidities by vulnerable older adults. J Health Care Poor Underserved2009; 20: 134–151.
9.
BrundisiniFVanstoneMHulanDet al.Type 2 diabetes patients' and providers' differing perspectives on medication nonadherence: a qualitative meta-synthesis. BMC Health Serv Res2015; 15: 516–539–516–539.
10.
Kenning C, Fisher L, Bee P, et al. Primary care practitioner and patient understanding of the concepts of multimorbidity and self-management: A qualitative study. SAGE Open Med 2013; 1: 1–11.
11.
ZulmanDMKerrEAHoferTPet al.Patient-provider concordance in the prioritization of health conditions among hypertensive diabetes patients. J Gen Intern Med2010; 25: 408–414.
12.
HansenHSchaferISchonGet al.Agreement between self-reported and general practitioner-reported chronic conditions among multimorbid patients in primary care - results of the MultiCare Cohort Study. BMC Fam Pract2014; 15: 39–53–39–53.
13.
MorrisRLSandersCKennedyAPet al.Shifting priorities in multimorbidity: a longitudinal qualitative study of patient's prioritization of multiple conditions. Chronic Illn2011; 7: 147–161.
14.
ShippeeNDShahNDMayCRet al.Cumulative complexity: a functional, patient-centered model of patient complexity can improve research and practice. J Clin Epidemiol2012; 65: 1041–1051.
15.
Zullig LL, Whitson HE, Hastings SN, et al. A systematic review of conceptual frameworks of medical complexity and new model development. J Gen Int Med 2016; 31: 329–337.
16.
Cheraghi-SohiSBowerPKennedyAet al.Patient priorities in osteoarthritis and comorbid conditions: a secondary analysis of qualitative data. Arthritis Care Res (Hoboken)2013; 65: 920–927.
17.
Cheraghi-Sohi S, Morden A, Bower P, et al. Exploring patient priorities among long-term conditions in multimorbidity: A qualitative secondary analysis. SAGE Open Med 2013; 1: 1–9.
18.
BowerPHarknessEMacdonaldWet al.Illness representations in patients with multimorbid long-term conditions: qualitative study. Psychol Health2012; 27: 1211–1226.
19.
Fix GM, Cohn ES, Solomon JL, et al. The role of comorbidities in patients' hypertension self-management. Chronic Illn 2014; 10: 81–92.
20.
KerrEAHeislerMKreinSLet al.Beyond comorbidity counts: how do comorbidity type and severity influence diabetes patients' treatment priorities and self-management?J Gen Intern Med2007; 22: 1635–1640.
21.
BeverlyEAWrayLAChiuCJet al.Perceived challenges and priorities in co-morbidity management of older patients with Type 2 diabetes. Diabet Med2011; 28: 781–784.
BoydCBoultCShadmiEet al.Guided care for multimorbid older adults. Gerontologist2007; 47: 697–704.
24.
BaylissEAEdwardsAESteinerJFet al.Processes of care desired by elderly patients with multimorbidities. J Fam Pract2008; 25: 287–293.
25.
TinettiMEFriedTRBoydCM. Designing health care for the most common chronic condition—multimorbidity. JAMA2012; 307: 2493–2494.
26.
Mc SharryJBishopFLMoss-MorrisRet al.‘The chicken and egg thing’: Cognitive representations and self-management of multimorbidity in people with diabetes and depression. Psychol Health2012; 28: 103–119.
27.
ZulmanDMJenchuraECCohenDMet al.How can eHealth technology address challenges related to multimorbidity? Perspectives from patients with multiple chronic conditions. J Gen Intern Med2015; 30: 1063–1070.
28.
FormanJDamschroderLJQualitative content analysis. In: JacobyLSiminoffL (eds). Empirical research for bioethics: a primer, Oxford, UK: Elsevier Publishing, 2008.
29.
FernaldDHDuclosCW. Enhance your team-based qualitative research. Ann Fam Med2005; 3: 360–364.
SmithSMSoubhiHFortinMet al.Interventions for improving outcomes in patients with multimorbidity in primary care and community settings. Cochr Database Syst Rev2012; 4: CD006560–CD006560.
32.
BodenheimerTLorigKHolmanHet al.Patient self-management of chronic disease in primary care. JAMA2002; 288: 2469–2475.
33.
ManginDHeathIJamoulleM. Beyond diagnosis: rising to the multimorbidity challenge. BMJ2012; 344: e3526–e3526.
34.
Schulman-GreenDJNaikADBradleyEHet al.Goal setting as a shared decision making strategy among clinicians and their older patients. Patient Educ Couns2006; 63: 145–151.
35.
BaylissEABosworthHBNoelPHet al.Supporting self-management for patients with complex medical needs: recommendations of a working group. Chronic Illn2007; 3: 167–175.
36.
FriedTRTinettiMEIannoneL. Primary care clinicians' experiences with treatment decision making for older persons with multiple conditions. Arch Intern Med2011; 171: 75–80.
37.
BerkmanNDSheridanSLDonahueKEet al.Low health literacy and health outcomes: an updated systematic review. Ann Intern Med2011; 155: 97–107.
38.
KreinSLHoferTPHollemanRet al.More than a pain in the neck: how discussing chronic pain affects hypertension medication intensification. J Gen Intern Med2009; 24: 911–916.
39.
Guiding principles for the care of older adults with multimorbidity: an approach for clinicians: American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity. J Am Geriatr Soc 2012; 60: E1–E25.
