Interventions to Enhance Patient and Family Engagement Among Adults With Multiple Chronic Conditions

Abstract

Purpose: In the United States, 42% of adults, and 81% of adults over 65 years of age live with multiple chronic condition (MCC). Current interventions to facilitate engagement in care focus primarily on the patient; however, many individuals with MCC manage and live with their conditions within the context of their family. This review sought to identify interventions used to facilitate patient and/or family engagement among adults with MCC. Methods: We adhered as closely as possible to PRISMA guidelines and conducted a systematic scoping review using a modified approach by Arksey and O’Malley. We searched PubMed, Web of Science, and Scopus using terms related to MCC, patient and family engagement, and intervention. We included articles that: (1) were published in English; (2) were peer-reviewed; (3) described an engagement intervention (with or without a comparator); and (4) targeted individuals with MCC. We abstracted data from included articles and classified them using the Multidimensional Framework for Patient and Family Engagement in Health and Health Care, and the Classification Model of Patient Engagement. Results: We identified 21 discrete interventions. Six (29%) were classified as having the highest degree of engagement. Eighteen (85%) focused on engagement at the direct care level. Only one was specifically designed to engage families. Conclusions: Many engagement interventions currently exist for adults with MCC. Few of these interventions foster the highest degree of engagement; most focus on engagement at the level of direct care and do not specifically target family member involvement.

Building Resilient Health Systems: Patient Safety during COVID-19 and Lessons for the Future

“…Patient and family engagement hold the key: Five articles demonstrated, the importance of empowering patients using health literacy programmes including, behavioural change communication strategies, patient groups involvement in development of service delivery policies and strategies and IT/mobile based grievance reprisal system (Daniel et al, 2020; Elwyn & Price, 2020; Johari et al, 2020; Kuriakose et al, 2020; McCarron et al, 2020).…”

“…• Equity in access: Three articles highlighted inequity in access to services during COVID-19 times and reinforced the need for additional mechanisms to improve coverage of health services such as supplemental immunisation, catch-up campaigns, home delivery of medicines and mobile van clinics at remote places for poor and marginalised groups (Barnabas et al, 2020;Govender et al, 2020;Wang & Tang, 2020). • Patient and family engagement hold the key: Five articles demonstrated, the importance of empowering patients using health literacy programmes including, behavioural change communication strategies, patient groups involvement in development of service delivery policies and strategies and IT/mobile based grievance reprisal system (Daniel et al, 2020;Elwyn & Price, 2020;Johari et al, 2020;Kuriakose et al, 2020;McCarron et al, 2020).…”

A scoping review of person and family engagement in the context of multiple chronic conditions

“…Of the six included reviews, just one explicitly described itself as a review of “engagement” using the term explicitly; this review focused on interventions (Table 4). 33 Another review focused on interventions involving individuals with MCCs in decision making, 30 and four reviews focused on self‐management among those with MCC. Of the four reviews of self‐management, two described characteristics and challenges of self‐management, 31,35 one described the assessment of self‐management, 35 and one focused on self‐management interventions 34 .…”

“…Daniel et al (the only review explicitly focused on “engagement”) categorized 21 interventions by levels of care as conceptualized by Carman et al 22 and identified 18 that addressed direct care, 1 that addressed organizational design and governance, and 2 that encompassed both direct care and organizational design and governance; none focused on policy. Four interventions were classified as comprising passive information provision, 11 as comprising information and activation, and 6 were classified as information, activation, and collaboration, “the highest level of engagement” per Grande et al's 2014 classification framework 23,33 . Three of 21 discrete interventions in Daniel's review explicitly targeted family/friends; the other reviews did not address family/friends explicitly.…”

“…The three reviews of interventions found variation in evaluated outcomes. Daniel identified 27 outcomes such as patient empowerment/activation, quality of life, quality of care, physiologic measures, treatment adherence, services use, and clinician satisfaction 33 . Miller examined primary outcomes only and identified 13 categories of outcomes including disease‐specific outcomes, general health outcomes, and self‐management behaviors 34 .…”