Patients' experiences of coping with multiple chronic conditions: A qualitative descriptive study

Health Priorities in Chronic Obstructive Pulmonary Disease Patients with Multimorbidity: A Qualitative Study

PURPOSE

To explore the health priorities of patients with multimorbidity in COPD and the factors as to why their condition is prioritized.

METHODS

This qualitative study was conducted from February to April 2022 at a hospital in China. A specially selected sample of 18 patients completed a general information sheet and face-to-face interviews. The Colaizzi method was used to analyze the data.

RESULTS

Participants reported their experience which fell into three themes: disease burden, health perception and views of others. In addition, participants explained that health knowledge from short videos on mobile apps influenced them, which in turn influenced their ranking.

CONCLUSION

Our findings suggested that health priorities of patients with multimorbidity in COPD manifest differently. Specifically, our findings suggested that patients' health priorities are most influenced by disease burden, health perception, and the opinions of those around them. Nursing staff should fully understand each patients'own perspectives and provide them with personalized support.

Everyday Lives of Middle-Aged Persons with Multimorbidity: A Mixed Methods Systematic Review

The healthcare burden of patients with multimorbidity may negatively affect their family lives, leisure time and professional activities. This mixed methods systematic review synthesizes studies to assess how multimorbidity affects the everyday lives of middle-aged persons, and identifies skills and resources that may help them overcome that burden. Two independent reviewers screened title/abstracts/full texts in seven databases, extracted data and used the Mixed Methods Appraisal Tool (MMAT) to assess risk of bias (RoB). We synthesized findings from 44 studies (49,519 patients) narratively and, where possible, quantitatively. Over half the studies provided insufficient information to assess representativeness or response bias. Two studies assessed global functioning, 15 examined physical functioning, 18 psychosocial functioning and 28 work functioning. Nineteen studies explored skills and resources that help people cope with multimorbidity. Middle-aged persons with multimorbidity have greater impairment in global, physical and psychosocial functioning, as well as lower employment rates and work productivity, than those without. Certain skills and resources help them cope with their everyday lives. To provide holistic and dynamic health care plans that meet the needs of middle-aged persons, health professionals need greater understanding of the experience of coping with multimorbidity and the associated healthcare burden.

Multimorbidity in Hospitalized Patients Admitted to General Practice Departments and Its Implications for the General Practice Healthcare System: A Four-Year Longitudinal Study in China

Objective: China and many developing countries has placed high expectations on the general practice healthcare system in terms of lowering medical costs and improving the health status of the multimorbid population in recent years. However, the prevalence of multimorbidity among inpatients attending the general practice department of hospitals and its policy implications are largely unknown. The current study aimed to analyze the prevalence of comorbidities among inpatients attending the general practice department of the tertiary Grade-A Hospitals in China, and put forward evidence-based policy recommendations.

Methods: Between December 2016 and November 2020, 351 registered general practitioners from 27 tertiary hospitals were selected, and their direct admissions were evaluated. The rate and composition ratio were used for descriptive analysis of the clinical and epidemiological characteristics of multimorbidity. A backward stepwise algorithm was used to explore independent variables. The absence of multicollinearity and plausible interactions among variables were tested to ensure the robustness of the logistic regression model. The pyramid diagram was used to show the link between gender and the involved human body system in multimorbidity.

Results: Multimorbidity was present in 93.1% of the 64, 395 patients who were admitted directly. Multimorbidity was significantly more prevalent in patients aged 45–59 years (OR=3.018, 95% CI=1.945–4.683), 60–74 years (OR = 4.349, 95% CI = 2.574–7.349), ≥75 years (OR = 7.804, 95% CI = 3.665–16.616), and those with body mass index (BMI) ≥ 28 kg/m² (OR = 3.770, 95% CI = 1.453–9.785). The circulatory system was found to be the most commonly involved human body system in multimorbidity, accounting for 79.2% (95% CI = 78.8–79.5%) of all cases. Significant gender inequity was further observed in the involved human body system in multimorbidity.

Conclusion: Multimorbidity is likely common among the inpatients attending the general practice department of hospitals in China and many developing countries, with significant gender inequity in the involved human body systems. Effective countermeasures include establishing a GP-PCIC multimorbidity prevention and control model and enhancing the multimorbidity of elderly and obese patients at both the clinical and healthy lifestyle levels. The diagnosis and treatment capabilities of GPs on the circulatory, endocrine, metabolic, digestive, and respiratory systems should be prioritized.

Coping with Multiple Chronic Conditions in the Family Context: A Meta-Synthesis

This study was to collect, synthesize, and interpret the current qualitative evidence from studies that investigated family coping among people with multiple chronic conditions (MCCs). A meta-synthesis approach was used to report this study. A systematic search was performed in five electronic databases, including CINAHL, EMBASE, PsycINFO, Web of Science, and PubMed from January 2000 to December 2020. The PRISMA flow chart and Joanna Briggs Institute Qualitative Assessment and Review Instrument checklist are integrated into the meta-synthesis. A total of ten eligible studies including data from 381 participants were identified. Three meta-themes were identified in the synthesis: (1) family role maintenance in MCCs management, (2) coping as a family, and (3) be frustrated with family interactions. This meta-synthesis indicated the importance of maintaining social roles and family support within family interactions for coping with MCCs. It also demonstrated the frustrations in the family coping process experienced by people with MCCs. Health care professionals should understand the interactions between people with MCCs and their family members that may impact people's coping. Such an understanding may contribute to the development of supportive programs such as family-based interventions for people with MCCs.

Care and treatment needs of immunosuppressive therapy patients with warts and impact on everyday life: a qualitative study

INTRODUCTION

Patients receiving immunosuppressive therapy have an increased risk of developing verrucae vulgaris (warts). They often suffer from dissemination of numerous warts, complicated by low treatment response and long-term treatment. How patients experience these challenges is not well characterized. The aim of this study was to explore how patients on immunosuppressive therapy experience everyday life with warts on the hands and feet, and their needs related to care and treatment.

METHODS

The study took a phenomenological-hermeneutic approach. Semi-structured interviews were conducted with 10 adults. Data were analyzed using the thematic analysis described by Braun and Clark.

RESULTS

Warts on the hands and feet impact everyday life and cause feelings of stigma and pain. Patients request treatment and hope to be cured although the prospects are poor. Self-treatment is experienced as a burden, because of the need for more specific information about and skills to treat the warts, and because individual patients' resources are not considered. Patients experience a lack of care continuity.

CONCLUSIONS

Patients request a person-centred care and treatment approach, to establish a relationship with health care professionals. Establishing care continuity might reduce patients' treatment-related insecurity.

Disability and its association with psychological factors in multiple sclerosis patients

BACKGROUND

Multiple Sclerosis (MS) is a neurological, and immune-mediated demyelinating disease. Psychological factors in MS disease and psychosocial interventions based on these factors have a major role in the adjustment of MS patients toward their disease. The aim of the study was to compare the psychological components of happiness, psychological well-being, love of life, meaning in life, and somatic health between MS patients with low Expanded Disability Status Scale (EDSS) scores and MS patients with higher EDSS scores.

METHOD

A sample of 128 patients with MS was recruited. Patients were administered the EDSS, the Self-Rating Scale of Happiness (SRH), the World Health Organization-five Well-Being Index (WHO-5), the Love of Life Scale (LLS), the Meaning in Life Questionnaire (MLQ) and the Patient Health Questionnaire-15 (PHQ-15). Patients with EDSS>3 (cases) and EDSS≤3 (controls) were compared.

RESULTS

The cases had lower scores for happiness, love of life, psychological well-being, meaning in life, the present of meaning in life subscale, and somatic health, compared with the controls. The differences between cases and controls remained statistically significant after controlling for age and sex.

CONCLUSION

Positive health promotion and education intervention programs to reduce disability and increase MS patients' well-being should be one of the priorities in the Iran healthcare system for MS patients. Therapists should take these components into account when working with MS patients with moderate and severe disability.

Liver cirrhosis turns life into an unpredictable roller coaster: A qualitative interview study

Aim

To explore how persons living with liver cirrhosis experience day‐to‐day life.

Background

Liver cirrhosis is the sixth most common cause of death among adults in Western countries. Persons with advanced liver cirrhosis report poor quality of life, in comparison with other chronic diseases. However, knowledge regarding day‐to‐day life during earlier stages of the disease is lacking. In other chronic diseases, the suffering process is well explored, while in liver cirrhosis, suffering is insufficiently investigated.

Design

An exploratory study, with a qualitative inductive interview approach.

Methods

A purposive maximum variation sample of 20 informants with liver cirrhosis aged 25–71, from two gastroenterology outpatient clinics in mid‐Sweden, were interviewed from September 2016 to October 2017. Interview data were analysed inductively with qualitative content analysis. Reporting followed the COREQ guidelines.

Results

The experiences of day‐to‐day life living with liver cirrhosis comprised four sub‐themes. Living with liver cirrhosis implied varying levels of deterioration, the most apparent being exhaustion or tiredness. The informants had to find ways of adapting to a new life situation. The insecurity of future health evoked existential reflections such as feeling emotionally and existentially distressed. Shame and guilt were reasons for feeling stigmatised. These sub‐themes emerged into one overarching theme of meaning: life turns into an unpredictable roller coaster. This is based on experiences of liver cirrhosis as an unpredictable disease with fluctuating symptoms, worries and disease progression.

Conclusion

Living with cirrhosis implies an unpredictable condition with a progressive, stigmatising disease. The fluctuating symptoms and deep concerns about future life pose an increased personal suffering.

Relevance to clinical practice

Within health care, knowledge of the person's experience is vital to enable and fulfil the person's healthcare needs. Clinical registered nurses need a person‐centred approach to strengthen their patients to cope with their new life situation.

Psychometric Testing of the Chinese Version of the Coping and Adaptation Processing Scale-Short Form in Adults With Chronic Illness

Background

Adaptive capacity may serve as an indicator of the individuals’ coping behaviors toward illness management and may contribute to day-to-day living with chronic illness and improved quality of life. Practical and well-constructed instruments for measuring adaptation have not been adequately explored. An English 15-item Coping and Adaptation Processing–Short Form (CAPS-SF) for assessing adaptation has been created and validated in line with the underlying tenets of Coping and Adaptation Processing theory, but there is no applicable Chinese version.

Methods

The CAPS-SF was translated and culturally adapted into simplified Chinese. Among Chinese adults with chronic illness, 81 patients were selected for cultural adaptation and 288 patients were approached for psychometric testing. Content validity was evaluated by an expert panel. Construct validity was tested by confirmatory factor analysis. Concurrent validity and predictive validity were analyzed by Spearman correlation coefficient. Reliability was assessed by internal consistency and test–retest coefficients. Floor/ceiling effect was calculated.

Results

Adequate content validity was ensured by the expert panel. A four-factor structure (resourceful and focused, self-initiated and knowing-based, physical and fixed, and positive and systematic) describing individuals’ coping strategies was identified and verified. Concurrent validity and predictive validity were demonstrated by strong correlations with the confrontation of coping mode (r = 0.46) and a quality-of-life measure (r = 0.58). The McDonald’s omega coefficient of total scale was 0.82. Split-half reliability and test–retest reliability were 0.87 and 0.87. No floor/ceiling effect was present.

Conclusion

The Chinese version CAPS-SF is a theoretically based and culturally acceptable instrument with sound psychometric properties. Further studies are advocated to refine its four-factor structure.