Patient and Provider Perspectives on the Relationship Between Multiple Morbidity Management and Disease Prevention

Abstract

Despite competing demands of multiple morbidity (MM) management and disease prevention, our recent survey of 1,153 Appalachian residents aged 50 to 76 documented that individuals with MM were more likely to obtain colorectal cancer screening (CRCS) than those without MM. Nearly two thirds of respondents obtained CRCS, and the more MM, the greater the likelihood of screening. To gain insight into this relationship, we conducted nine focus groups, six with providers and three with patients. Three main explanations emerged: (a) patients’ MM increases providers’ vigilance for other health vulnerabilities; (b) having MM increases patients’ own vigilance; and (c) patients’ vigilance may stem from experiencing more symptoms, having a family history of cancer, and having successfully obtained health care. More frequent contact with health care providers appears to encourage preventive referral, especially in low-income populations that otherwise may not receive such counselling. We highlight participant recommendations to improve MM management and prevention.

Barriers and facilitators towards colonoscopy: a qualitative systematic review

“…The lack of necessity for regular follow-up investigations has also motivated patients to seek colonoscopy (Ghanouni et al ., 2012). Additionally, patients regarded the presence of sedation (Friedemann-Sánchez et al ., 2007; Von Wagner et al ., 2009b; Bass et al ., 2011; Mikocka-Walus et al ., 2012), rapid diagnosis (von Wagner et al ., 2009a; Bass et al ., 2011; Ghanouni et al ., 2012; Mikocka-Walus et al ., 2012) and assurance from the transparency of the procedure (Nguyen et al ., 2010; Foo et al ., 2012; Schoenberg et al ., 2015) as facilitators.…”

“…Patients have also highlighted their lack of knowledge on colonoscopy recommendation guidelines (Foo et al ., 2012), logistical preparations (Jones et al ., 2010) and procedural details (Bass et al ., 2011; Lee, 2018). Providers noted that patients who rarely visit doctors would be unaware of how colonoscopy is the gold standard for CRC diagnosis (Schoenberg et al ., 2015). Physicians opined that public education on improved CRC prognosis when detected early is crucial (Ward et al ., 2010), and the designation of health educators in clinics to explain procedures will boost colonoscopy uptake (Goodman et al ., 2006).…”

Health Shocks and Initiation of Use of Preventive Services Among Older Adults

“…In particular, this study has shown that a hospital stay lasting 3 or more nights nearly always has significant positive effects on initiating use of preventive services. Such stays are likely sending a strong signal that health is in danger, and the time in the hospital increases opportunities for patient reflection and education about the need to use preventive services (Schoenberg, Tarasenko, Bardach, & Fleming, 2015).…”

Chronic Disease and Aging

“…In using empirical survey data to inform subsequent in-depth, qualitative data collection, Schoenberg, Tarasenko, Bardach, and Fleming (2015) examine the intersection between multi-morbidity and an increased likelihood of colorectal cancer screening among Appalachian residents aged 50 to 76. Themes emerging from nine focus groups (six consisting of providers and three of patients) suggested that multi-morbidity increased providers’ and patients’ vigilance for health complications, and the more frequent contact with health care providers due to these issues resulted in preventive actions such as colorectal screenings.…”