Value Of Self-management Research Articles

Use and value of self-management (SM) recommendations in a real-world evidence study evaluating digital patient monitoring (DPM) of patients (pts) receiving cancer care.

1603 Background: SM includes pts’ abilities and activities to manage symptoms, treatment (tx), and any problems inherent to a chronic condition. Tailored SM support is recommended in cancer care. DPM enables pts to systematically self-report disease- or tx-related symptoms, communicate directly with healthcare professionals (HCPs), and access support materials. This observational study evaluated the real-world use of the Symptom Navi Program (SNP; Bern, Switzerland) SM materials on the Kaiku Health DPM platform (Helsinki, Finland) in collaboration with F. Hoffmann-La Roche Ltd (Roche; Basel, Switzerland). Methods: Adults diagnosed with locally advanced or metastatic non-small/small cell lung cancer, or any stage HER2-positive breast cancer being treated with locally approved and reimbursed drugs with an expected tx duration of >3 months, had access to a DPM solution that provided disease- and tx-tailored modules, including SNP SM recommendations for selected mild or moderate symptoms. The co-primary endpoints were DPM adoption and adherence. Here we report secondary endpoints; the perceived clinical impact, DPM module and service experience (assessed via Customer Effort Score [CES] and Customer Satisfaction Score [CSS]), and use of DPM features such as SM recommendations, via a DPM tool questionnaire. Results: Of the 89 enrolled pts, 66 had completed the DPM tool questionnaire at Week 6 of DPM use (data cutoff: June 9, 2022). Among the educational content, the symptom feedback library was accessed most. Pts spent up to a median of 12 minutes on Roche educational or SNP SM materials. The majority of pts (45/66 [68%]) considered the symptom questionnaires to cover all/most of the symptoms they experienced; 18/66 (27%) experienced only fair/partial symptom coverage; 49% (25/51) of pts whose symptoms were not covered contacted their HCP team. 34 pts (52%) took action based on the symptom questionnaire feedback; the most common action was SM recommendations applied according to symptom level (21/66 [32%]), followed by sending a message via the platform to the care team (8/66 [12%]). Half of pts found the SNP SM recommendations helpful/very helpful and 22 pts agreed that the SNP SM recommendations almost always/sometimes supported them in delaying contacting an HCP at an emergency room. At Week 6, the CES was 80%, CSS was 71%, and 48% (32/66) of pts felt that this service improved their care. Conclusions: Pt feedback showed that SNP SM recommendations were the most used action in response to the symptom questionnaire feedback and were perceived by most to be helpful/very helpful. These results support the use of SM recommendations in pts with cancer to help them self-manage tx-related symptoms experienced; future studies are needed to further explore their impact and usefulness, and to form recommendations for routine use in clinical practice.

Anxiety in female adolescents with autism spectrum disorder: Lessons for healthcare professionals

Background: Despite awareness of the high prevalence of anxiety in females with autism spectrum disorders (ASD), females report high unmet service needs regarding mental health concerns. Aim: This study explored experiences of anxiety in female adolescences with ASD, their management of it, and their experiences of mental health services in the United Kingdom. Methods: Utilising an Interpretative Phenomenological Analysis, six females with ASD, aged between 13 to 15 years and referred to mental health services, took part in semi-structured interviews. Results: The analysis generated the following themes: the central experience of anxiety; the impact of the surrounding world; mismatch between needs and support; and the value of self-management. The themes emphasised a need for a more general acceptance of ASD-related anxiety triggers such as sensory overload and uncertainty to change. Discussion: Adolescents raised concerns around the appropriateness of support provided for their anxiety, including awareness raising initiatives around ASD which only served to heighten their anxiety. Conclusions: Healthcare professionals need to have a better understanding of ASD-related anxiety in females. To improve outcomes, better service knowledge and communications around ASD-related anxiety are important for the assessment of anxiety as well as tailored ASD interventions.

Activation to self-management and exercise in overweight and obese older women with knee osteoarthritis.

Knee osteoarthritis (OA) affects approximately 1 in 10 adults in the United States, with higher prevalence in women, aggravated by increased weight. This quasi-experimental pilot study implemented an online self-management (SM) program for older overweight and obese women with knee OA combined with a two-arm progressive exercise trial (walking and stepping groups). After the 10-week intervention using an interprofessional approach, activation to SM scores were significantly higher in all participants (N = 16) and between groups, with a higher increase in the stepping group. Those with higher activation scores pre-intervention obtained higher scores post-intervention. Activation levels also increased significantly among all participants with majority at the highest activation level. Follow-up data at 6 weeks and 6 months showed sustained SM and health-directed behaviors. These findings, although preliminary, highlight the value of combined SM and progressive exercise intervention using an interprofessional approach. Further investigations are essential toward potential practice and policy changes.

Self-management programmes for COPD

Self-management is of increasing importance in chronic obstructive pulmonary disease (COPD) management. However, there is confusion over what processes are involved, how the value of self-management should be determined, and about the research priorities. To gain more insight into and agreement about the content of programmes, outcomes, and future directions of COPD self-management, a group of interested researchers and physicians, all of whom had previously published on this subject and who had previously collaborated on other projects, convened a workshop. This article summarises their initial findings. Self-management programmes aim at structural behaviour change to sustain treatment effects after programmes have been completed. The programmes should include techniques aimed at behavioural change, be tailored individually, take the patient's perspective into account, and may vary with the course of the patient's disease and co-morbidities. Assessment should include process variables. This report is a step towards greater conformity in the field of self-management. To enhance clarity regarding effectiveness, future studies should clearly describe their intervention, be properly designed and powered, and include outcomes that focus more on the acquisition and practice of new skills. In this way more evidence and a better comprehension on self-management programmes will be obtained, and more specific formulation of guidelines on self-management made possible.

Working with Self-management Courses – The Thoughts of Participants, Planners and Policy Makers

Foreword: Interview with Professor Kate Lorig 1. UK origins and arguments 2. The ideas and health context where self-management emerged 3. Participants views: Scottish Lowlands Tower Hamlets The Christie, Manchester 4. Advanced journeys into self-management: A personal journey The HOPE course Developing the staying positive programme for adolescents 5. The principles of lay leadership 6. Delivering courses now: Looking at the Expert Patients Programme The programme in Scotland Why we chose to get involved with self-management in Tower Hamlets Still questions after 15 years of experience The online opportunity Maintaining standards 7. The value of self-management: retrieving a sense of self: the loss and reconstruction of a life 8. Self-management and government policy 9. The business case for lay-led self-management 10. Implementing the pilot EPP 11. Self-management and public & patient involvement 12. The Expert Patient Programme community interest company: the future 13. Co-creating health: transforming healthcare systems 14. Three bodies of UK research: Coventry University Applied Research Centre The National Primary Care Research and Development Centre, Manchester Learning from co-creating health 15. What do we really know about benefits and value? 16. Which way is forward?

How important is patient self-management?

This chapter addresses the issues associated with self-management in arthritis care. Alternative approaches to traditional medical care have gained popularity in the past decade. Some of the factors that have led to this are discussed in this chapter, including personal self-determination, the patient as consumer in a global economy, the backlash against medical technology, and fundamental questions about the medical model of care. Following this introduction, the goals of the Arthritis Self-Management and Bone-up on Arthritis Programs are outlined, along with the major theoretical underpinnings of both programmes. The impact of self-management programmes on the outcomes of disability, pain, depression and fatigue are reviewed, as are the potential implications for both the direct and indirect cost savings for a health system and society. The potential negative effects of self-management programmes are considered, and issues related to implementation, dissemination, quality control and long-term maintenance are reviewed. Finally, the value of self-management as a tool to be used effectively by the person with arthritis, in conjunction with his or her rheumatologist, is outlined. The relevance of well-established, valid and reliable self-management programmes is underscored by the growing number of people who seek help over the Internet. Without guidance, information can become harmful or distracting rather than helpful.