title: Cascading crises, resilience and social support within the onset and development of multiple chronic conditions.
abstract: OBJECTIVE
  To describe and better understand adults' responses to the onset, accrual and influence of multiple chronic conditions and to social support in adapting to consequent difficulties.
  
  
  METHODS
  Qualitative study of 33 adults with multiple chronic illnesses randomly sampled from an urban primary care clinic. Semi-structured interviews targeted retrospective accounts of illness onset, consequent loss, as well as current accounts of social support and adaptation. All interviews were audio-recorded, professionally transcribed and analysed according to established phenomenological procedures.
  
  
  RESULTS
  Participants' responses revealed illness onset as a virtual cascade of medical, emotional and social hardships, leading to loss and subsequent adaptation through personal resilience and particularly, available social support. Participants also described patterns of adaptation punctuated by the felt need and rewards of providing care to others.
  
  
  CONCLUSIONS
  The experience of multiple chronic illnesses has a distinct pattern of development and consequence, involving challenges to personal identity and the benefits of social support from and to others. Our results suggest that programmes addressing the needs of persons with multiple chronic conditions might tailor interventions in ways that maximally address their unique challenges.
authors.affiliation: Yale Program for Recovery & Community Health, Yale Medical School, New Haven, Connecticut, USA. david.sells@yale.edu
authors.forename: Dave
authors.initials: D
authors.lastname: Sells
authors.forename: William H
authors.initials: WH
authors.lastname: Sledge
authors.forename: Melissa
authors.initials: M
authors.lastname: Wieland
authors.forename: David
authors.initials: D
authors.lastname: Walden
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Flanagan
authors.forename: Rebecca
authors.initials: R
authors.lastname: Miller
authors.forename: Larry
authors.initials: L
authors.lastname: Davidson
mesh_terms: D000222:Adaptation, Physiological; D000223:Adaptation, Psychological; D000368:Aged; D002908:Chronic Disease; D005260:Female; D006304:Health Status; D006801:Humans; D007398:Interpersonal Relations; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D012189:Retrospective Studies; D012944:Social Support; D013315:Stress, Psychological