"They are interrelated, one feeds off the other": A taxonomy of perceived disease interactions derived from patients with multiple chronic conditions.
Donna M Zulman, Cindie A Slightam, Kirsten Brandt and 3 others
PMID 31787406WHAT IT FOUND
Patients with multiple chronic conditions described interactions among their problems and treatments as one-way, circular, unclear, or none.
Pain, depression and limited movement often made managing another condition harder.
Key findings
01Patients described four broad categories of perceived condition interactions: unidirectional interactions among conditions or treatments, cyclical or multidimensional interactions, uncertain or indistinct interactions, and no interaction.
02Physical and mental health commonly interacted in patients' reports: limited movement increased depression and PTSD symptoms, and depression made proactive physical care harder.
03In exploratory survey analyses, a greater proportion of patients reported perceived condition interactions when they were younger (53.3% of patients under 65 vs. 30.2% of patients 65 or older), female (62.5% vs. 38.3% among males), disabled (65.3%, vs. 35.2 to 48.5% in other employment groups), and had more chronic conditions (57.9% with 6 or more conditions, 45.3% with 4 to 5, and 31.3% with 2 to 3).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The sample was drawn from one academic medical center and one Veterans Affairs facility, was predominantly male, and had limited racial and ethnic diversity, so the findings may not fit other patient groups. Only 383 of 550 survey respondents were analysed, and 1800 were invited, so the response rate was 31%. The open-ended survey question did not allow follow-up of ambiguous answers or verification of the researchers' interpretation. This was not a conventional qualitative study because it lacked a qualitative sampling strategy and concurrent data collection and analysis. The associations between patient characteristics and perceived interactions were exploratory post-hoc analyses, not a tested intervention. The taxonomy was checked with 23 of 44 re-contactable patients, a small validation sample.
The easy way to misread this
Do not read this taxonomy as proof that asking patients about condition interactions improves self-management or adherence. The study describes patient perceptions from survey free text and exploratory associations, with no tested intervention or outcome.