Pursuing minimally disruptive medicine: disruption from illness and health care-related demands is correlated with patient capacity

Boehmer, Kasey R.; Shippee, Nathan D.; Beebe, Timothy J.; Montori, Víctor M.

doi:10.1016/j.jclinepi.2016.01.006

Cited by 42 publications

(41 citation statements)

References 49 publications

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“…Finally, our novel sub-focus on the relationship between health coaching and patient capacity will elucidate any basis to the hypothesis that we can enhance health in chronic conditions by focusing on developing a sub-category of coaching, deemed “Capacity Coaching.” This is in line with the extensive body of research growing to support the practice of Minimally Disruptive Medicine [13–15, 30–32], of which Capacity Coaching would be a component. Finally, to make it easier to design and implement effective health coaching interventions in support of the 66 % of Americans with chronic conditions, this review seeks to identify key characteristics of successful coaching interventions.…”

Section: Discussionsupporting

confidence: 75%

“…Furthermore, patients draw on capacity to make adaptations over time to overcome treatment burden associated with chronic conditions [14]. Studies that have examined capacity have shown that patients most disrupted by treatment had serious limitations to their physical, emotional, and financial capacities [15] while care plans that attended to patient capacity were more effective in reducing 30-day hospital readmissions [16]. …”

Section: Introductionmentioning

confidence: 99%

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Health coaching interventions for persons with chronic conditions: a systematic review and meta-analysis protocol

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BackgroundChronic conditions are increasingly more common and negatively impact quality of life, disability, morbidity, and mortality. Health coaching has emerged as a possible intervention to help individuals with chronic conditions adopt health supportive behaviors that improve both quality of life and health outcomes.Methods/designWe planned a systematic review and meta-analysis of the contemporary health coaching literature published in the last decade to evaluate the effect of health coaching on clinically important, disease-specific, functional, and behavioral outcomes. We will include randomized controlled trials or quasi-experimental studies that compared health coaching to alternative interventions or usual care. To enable adoption of effective interventions, we aim to explore how the effect of intervention is modified by the intervention components, delivering personnel (i.e., health professionals vs trained lay or peer persons), dose, frequency, and setting. Analysis of intervention outcomes will be reported and classified using an existing theoretical framework, the Theory of Patient Capacity, to identify the areas of patients’ capacity to access and use healthcare and enact self-care where coaching may be an effective intervention.DiscussionThis systematic review and meta-analysis will identify and synthesize evidence to inform the practice of health coaching by providing evidence on components and characteristics of the intervention essential for success in individuals with chronic health conditions.Systematic review registrationPROSPERO CRD42016039730Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0316-3) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 75%

Section: Introductionmentioning

confidence: 99%

Health coaching interventions for persons with chronic conditions: a systematic review and meta-analysis protocol

et al. 2016

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“…Impact refers to a patient's perception of the effect of the workload on role, social, physical, and psychological functioning. Financial challenges, confusion about medical information, and challenges with the healthcare system may add to the weight of the burden that is felt by the patient [2-6]. High treatment burden is an important clinical issue as evidence suggests that it may negatively affect behavioral and clinical outcomes such as adherence [7-11].…”

Section: Introductionmentioning

confidence: 99%

Development and validation of the Patient Experience with Treatment and Self-management (PETS): a patient-reported measure of treatment burden

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Purpose The purpose of this study was to develop and validate a new comprehensive patient-reported measure of treatment burden – the Patient Experience with Treatment and Self-Management (PETS). Methods A conceptual framework was used to derive the PETS with items reviewed and cognitively tested with patients. A survey battery, including a pilot version of the PETS, was mailed to 838 multi-morbid patients from two healthcare institutions for validation. Results A total of 332 multi-morbid patients returned completed surveys. Diagnostics supported deletion and consolidation of some items and domains. Confirmatory factor analysis supported a domain model for scaling comprised of 9 factors: medical information, medications, medical appointments, monitoring health, interpersonal challenges, medical/healthcare expenses, difficulty with healthcare services, role/social activity limitations, and physical/mental exhaustion. Scales showed good internal consistency (alpha range: 0.79 – 0.95). Higher PETS scores, indicative of greater treatment burden, were correlated with more distress, less satisfaction with medications, lower self-efficacy, worse physical and mental health, and lower convenience of healthcare (Ps<.001). Patients with lower health literacy, less adherence to medications, and more financial difficulties reported higher PETS scores (Ps<.01). Conclusion A comprehensive patient-reported measure of treatment burden can help to better characterize the impact of treatment and self-management burden on patient well-being and guide care toward minimally disruptive medicine.

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“…Still, patients may be able to draw upon available capacity in some domains in order to overcome limitations in others. They may also report surprisingly low disruption from illness and treatment despite high levels of healthcare work [3]. This suggests a dynamic relationship between elements of patients’ capacity that makes it on the whole difficult to define, measure, or discuss in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Patient capacity and constraints in the experience of chronic disease: a qualitative systematic review and thematic synthesis

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BackgroundLife and healthcare demand work from patients, more so from patients living with multimorbidity. Patients must respond by mobilizing available abilities and resources, their so-called capacity. We sought to summarize accounts of challenges that reduce patient capacity to access or use healthcare or to enact self-care while carrying out their lives.MethodsWe conducted a systematic review and synthesis of the qualitative literature published since 2000 identifying from MEDLINE, EMBASE, Psychinfo, and CINAHL and retrieving selected abstracts for full text assessment for inclusion. After assessing their methodological rigor, we coded their results using a thematic synthesis approach.ResultsThe 110 reports selected, when synthesized, showed that patient capacity is an accomplishment of interaction with (1) the process of rewriting their biographies and making meaningful lives in the face of chronic condition(s); (2) the mobilization of resources; (3) healthcare and self-care tasks, particularly, the cognitive, emotional, and experiential results of accomplishing these tasks despite competing priorities; (4) their social networks; and (5) their environment, particularly when they encountered kindness or empathy about their condition and a feasible treatment plan.ConclusionPatient capacity is a complex and dynamic construct that exceeds “resources” alone. Additional work needs to translate this emerging theory into useful practice for which we propose a clinical mnemonic (BREWS) and the ICAN Discussion Aid.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-016-0525-9) contains supplementary material, which is available to authorized users.

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Pursuing minimally disruptive medicine: disruption from illness and health care-related demands is correlated with patient capacity

Cited by 42 publications

References 49 publications

Health coaching interventions for persons with chronic conditions: a systematic review and meta-analysis protocol

Health coaching interventions for persons with chronic conditions: a systematic review and meta-analysis protocol

Development and validation of the Patient Experience with Treatment and Self-management (PETS): a patient-reported measure of treatment burden

Patient capacity and constraints in the experience of chronic disease: a qualitative systematic review and thematic synthesis

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