Abstract
BackgroundMultimorbidity poses a major health burden worldwide yet most healthcare is still orientated towards the management of single diseases. Literature on the experience of living with multimorbidity is accumulating but has not yet been synthesised in a manner conducive to informing the design of self-management interventions for this population. This study aimed to systematically review and synthesise findings from published, in-depth qualitative studies about the experience of multimorbidity, with a view to identifying the components and motivation for successful self-management in this population.MethodsSystematic review of and meta-synthesis of qualitative studies that evaluated patient experience of living with and/or self-managing mental and/or physical multimorbidity. MEDLINE, Embase, PsycINFO, CINAHL, and ASSIA along with reference lists of existing reviews and content pages of non-indexed specialists comorbidity journals were searched.ResultsNineteen studies from 23 papers were included. A line of argument synthesis was articulated around three third-order constructs: 1) Encounters with complexity; 2) Marshalling medicines, emotions, and resources; and 3) Self-preservation and prevention. Our interpretation revealed how mental and physical multimorbidity is experienced as moments of complexity rather than mere counts of illnesses. Successful self-management of physical symptoms was contingent upon the tactical use of medicines, whilst emotional health was more commonly managed by engaging in behavioural strategies, commonly with a social or spiritual component. Motivations for self-management were underpinned by a sense of moral purpose to take responsibility for their health, but also by a desire to live a purposeful life beyond an immediate context of multimorbidity.ConclusionsUnderstanding how people experience the complexities of mental and physical multimorbidity may be crucial to designing and delivering interventions to support successful self-management in this population. Future self-management interventions should aim to support patients to exert responsibility and autonomy for medical self-management and promote agency and self-determination to lead purposeful lives via improved access to appropriate social and psychological support.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-015-0345-3) contains supplementary material, which is available to authorized users.
Highlights
Multimorbidity poses a major health burden worldwide yet most healthcare is still orientated towards the management of single diseases
Multimorbidity was measured in 18 studies by counting the number of conditions participants had at time of recruitment; 11 studies recruited participants with at least 2 or more long-term conditions [7, 13, 26, 31, 34, 36, 37, 40, 45,46,47]; four studies recruited participants with at least ≥3 long term conditions [11, 12, 14, 20, 35]; one study recruited participants with ≥ 4 conditions [38, 43, 44, 48], and another study ≥5 conditions [24]
This systematic review and meta-synthesis was undertaken on the grounds that a broader understanding of patient experience of living with and coping with mental and physical multimorbidity is likely to be critical to designing interventions that support self-management in this population
Summary
Multimorbidity poses a major health burden worldwide yet most healthcare is still orientated towards the management of single diseases. Support for self-management is critical to the delivery of effective care for people with long term conditions, but achieving this is a challenge in multimorbid populations [7]. Primary care is often too fragmented and lacks continuity for people with multimorbidity, leading to inconvenience and hassles when interacting with multiple components of health services [8]. For their part practitioners report task uncertainty, burn out and heart sink from the ‘endless’ struggle to coordinate and manage the care of people with multimorbidity, making the delivery of patient centred care for this population less realisable [9, 10]
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