Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2016

Open Access 01-12-2016 | Research article

Meaningful conversations in living with and treating chronic conditions: development of the ICAN discussion aid

Authors: Kasey R. Boehmer, Ian G. Hargraves, Summer V. Allen, Marc R. Matthews, Christina Maher, Victor M. Montori

Published in: BMC Health Services Research | Issue 1/2016

Login to get access

Abstract

Background

The needs of the growing population of complex patients with multiple chronic conditions calls for a different approach to care. Clinical teams need to acknowledge, respect, and support the work that patients do and the capacity they mobilize to enact this work, and to adapt and self-manage. Tools that enable this approach to care are needed.

Methods

Using user-centered design principles, we set out to create a discussion aid for use by patients, clinicians, and other health professionals during clinical encounters. We observed clinical encounters, visited patient homes, and dialogued with patient support groups. We then developed and tested prototypes in routine clinical practice. Then we refined a final prototype with extensive stakeholder feedback.

Results

From this process resulted the ICAN Discussion Aid, a tool completed by the patient and reviewed during the consultation in which patients classified domains that contribute to capacity as sources of burden or satisfaction; clinical demands were also classified as sources of help or burden. The clinical review facilitated by ICAN generates hypotheses regarding why some treatment plans may be problematic and may not be enacted in the patient’s situation.

Conclusion

We successfully created a discussion aid to elucidate and share insights about the capacity patients have to enact the treatment plan and hypotheses as to why this plan may or may not be enacted. Next steps involve the evaluation of the impact of the ICAN Discussion Aid on clinical encounters with a variety of health professionals and the impact of ICAN-informed treatment plans on patient-important outcomes.
Literature
1.
Anderson GF. Chronic care: making the case for ongoing care. Princeton, NJ: Robert Wood Johnson Foundation; 2010.
2.
Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380(9836):37–43.CrossRefPubMed
3.
4.
5.
Shippee ND, Shah ND, May CR, Mair FS, Montori VM. Cumulative complexity: a functional, patient-centered model of patient complexity can improve research and practice. J Clin Epidemiol. 2012;65(10):1041–51.CrossRefPubMed
6.
Gallacher K, May CR, Montori VM, Mair FS. Understanding patients’ experiences of treatment burden in chronic heart failure using normalization process theory. Ann Fam Med. 2011;9(3):235–43.CrossRefPubMedPubMedCentral
7.
Gallacher K, Morrison D, Jani B, et al. Uncovering treatment burden as a key concept for stroke care: a systematic review of qualitative research. PLoS Med. 2013;10(6):e1001473.CrossRefPubMedPubMedCentral
8.
Sav A, Kendall E, McMillan SS, et al. ‘You say treatment, I say hard work’: treatment burden among people with chronic illness and their carers in Australia. Health Soc Care Community. 2013;21(6):665–74.PubMed
9.
Tran VT, Barnes C, Montori VM, Falissard B, Ravaud P. Taxonomy of the burden of treatment: a multi-country web-based qualitative study of patients with chronic conditions. BMC Med. 2015;13:115.CrossRefPubMedPubMedCentral
10.
May CR, Eton DT, Boehmer K, et al. Rethinking the patient: using Burden of Treatment Theory to understand the changing dynamics of illness. BMC Health Serv Res. 2014;14:281.CrossRefPubMedPubMedCentral
11.
Bayliss EA, Ellis JL, Steiner JF. Seniors’ self-reported multimorbidity captured biopsychosocial factors not incorporated into two other data-based morbidity measures. J Clin Epidemiol. 2009;62(5):550–7. e551.CrossRefPubMed
12.
Cottrell E, Yardley S. Lived experiences of multimorbidity: An interpretative meta-synthesis of patients’, general practitioners’ and trainees’ perceptions. Chronic Illn. 2015;11(4):279–303.CrossRefPubMed
13.
Loeb DF, Binswanger IA, Candrian C, Bayliss EA. Primary care physician insights into a typology of the complex patient in primary care. Ann Fam Med. 2015;13(5):451–5.CrossRefPubMedPubMedCentral
14.
O’Brien R, Wyke S, Guthrie B, Watt G, Mercer S. An ‘endless struggle’: a qualitative study of general practitioners’ and practice nurses’ experiences of managing multimorbidity in socio-economically deprived areas of Scotland. Chronic Illn. 2011;7(1):45–59.CrossRefPubMed
15.
16.
17.
Yardley S, Cottrell E, Rees E, Protheroe J. Modelling successful primary care for multimorbidity: a realist synthesis of successes and failures in concurrent learning and healthcare delivery. BMC Fam Pract. 2015;16:23.CrossRefPubMedPubMedCentral
18.
Boehmer KR, Gionfriddo MR, Rodriguez-Gutierrez R, Abu Dabrh AM, Leppin AL, Hargraves I, May CR, et al. "Patient capacity and constraints in the experience of chronic disease: a qualitative systematic review and thematic synthesis." BMC Family Practice. 2016;17(1):127.CrossRefPubMedPubMedCentral
19.
Breslin M, Mullan RJ, Montori VM. The design of a decision aid about diabetes medications for use during the consultation with patients with type 2 diabetes. Patient Educ Couns. 2008;73(3):465–72.CrossRefPubMed
20.
21.
22.
Demain S, Goncalves AC, Areia C, et al. Living with, managing and minimising treatment burden in long term conditions: a systematic review of qualitative research. PLoS One. 2015;10(5):e0125457.CrossRefPubMedPubMedCentral
23.
24.
25.
Nelson E, Wasson J, Kirk J, et al. Assessment of function in routine clinical practice: description of the COOP Chart method and preliminary findings. J Chronic Dis. 1987;40(Suppl 1):55S–69.CrossRefPubMed
26.
Weiner SJ, Schwartz A. Contextual Errors in Medical Decision Making: Overlooked and Understudied. Acad Med. 2016;91(5):657--62.
Metadata
Title
Meaningful conversations in living with and treating chronic conditions: development of the ICAN discussion aid
Authors
Kasey R. Boehmer
Ian G. Hargraves
Summer V. Allen
Marc R. Matthews
Christina Maher
Victor M. Montori
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2016
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-016-1742-6

Other articles of this Issue 1/2016

BMC Health Services Research 1/2016 Go to the issue

Research article

The promise and the reality: a mental health workforce perspective on technology-enhanced youth mental health service delivery

Research article

Organising medication discontinuation: a qualitative study exploring the views of general practitioners toward discontinuing statins

Research article

Patient activation in older people with long-term conditions and multimorbidity: correlates and change in a cohort study in the United Kingdom

Research article

Comparing routine administrative data with registry data for assessing quality of hospital care in patients with myocardial infarction using deterministic record linkage

Research article

A pilot study among older adults of the concordance between their self-reports to a health survey and spousal proxy reports on their behalf

Research article

The impact of the World Health Organization 8-steps in wheelchair service provision in wheelchair users in a less resourced setting: a cohort study in Indonesia