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. 2014 Dec;60(12):1123-33.

Challenges of self-management when living with multiple chronic conditions: systematic review of the qualitative literature

Clare Liddy, Valerie Blazkho, Karina Mill

Challenges of self-management when living with multiple chronic conditions: systematic review of the qualitative literature

Clare Liddy et al. Can Fam Physician. 2014 Dec.

Abstract
in English, French

Objective: To explore the perspectives of patients who live with multiple chronic conditions as they relate to the challenges of self-management.

Data sources: On September 30, 2013, we searched MEDLINE, EMBASE, and CINAHL using relevant key words including chronic disease, comorbidity, multimorbidity, multiple chronic conditions, self-care, self-management, perspective, and perception.

Study selection: Three reviewers assessed and extracted the data from the included studies after study quality was rated. Qualitative thematic synthesis method was then used to identify common themes. Twenty-three articles met the inclusion criteria, with most coming from the United States.

Synthesis: Important themes raised by people living with multiple chronic conditions related to their ability to self-manage included living with undesirable physical and emotional symptoms, with pain and depression highlighted. Issues with conflicting knowledge, access to care, and communication with health care providers were raised. The use of cognitive strategies, including reframing, prioritizing, and changing beliefs, was reported to improve people's ability to self-manage their multiple chronic conditions.

Conclusion: This study provides a unique view into patients' perspectives of living with multiple chronic conditions, which are clearly linked to common functional challenges as opposed to specific diseases. Future policy and programming in self-management support should be better aligned with patients' perspectives on living with multiple chronic conditions. This might be achieved by ensuring a more patient-centred approach is adopted by providers and health service organizations.

Objectif: Vérifier ce que pensent les patients qui vivent avec plusieurs maladies chroniques des défis associés à l’autogestion de leur condition médicale.

Sources des données: On a consulté MEDLINE, EMBASE et CINAHL le 30 septembre 2013 à l’aide des rubriques chronic disease, comorbidity, multimorbidity, multiple chronic conditions, self care, self management, perspective et perception.

Choix des études: Après avoir vérifié le niveau de qualité des études retenues, trois réviseurs les ont évaluées et en ont extrait les données. Une méthode de synthèse thématique qualitative a servi à identifier les thèmes.

Synthèse: Les thèmes importants mentionnés par les personnes souffrant de plusieurs maladies chroniques comprenaient leur capacité de gérer leur traitement, le fait de vivre avec des symptômes physiques et psychologiques indésirables, plus particulièrement la douleur et la dépression. Certains soulevaient des questions à propos des renseignements contradictoires, de l’accès aux soins et de la communication avec les soignants. Selon les participants, l’utilisation de stratégies cognitives, incluant un recadrage, une priorisation et des changements dans les croyances, pouvait améliorer leur capacité d’autogérer leurs multiples maladies chroniques.

Conclusion: Cette étude permet une vision unique de ce que pensent les patients du fait de vivre avec de multiples maladies chroniques, les défis qu’ils rencontrent étant clairement reliés à des difficultés de fonctionnement et non à des maladies particulières. Il serait opportun qu’à l’avenir, les politiques et les programmes de soutien à l’autogestion des problèmes de santé tiennent davantage compte de ce que pensent les patients qui vivent avec de multiples maladies chroniques. On pourrait y parvenir en s’assurant que les soignants et les organismes de santé utilisent une approche davantage centrée sur le patient.

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Figures

Figure 1.
Figure 1.
Flow diagram: Articles retrieved through search up to September 30, 2013.
Figure 2.
Figure 2.
Hudon and colleagues’ conceptual framework of patient-centred care Data from Hudon et al.
Figure 3.
Figure 3.
Common themes found in thematic synthesis as reported through the lens of Hudon and colleagues’ conceptual framework of patient-centred care Adapted from Hudon et al.
See this image and copyright information in PMC

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