title: Building a measurement framework of burden of treatment in complex patients with chronic conditions: a qualitative study.
abstract: BACKGROUND
  Burden of treatment refers to the workload of health care as well as its impact on patient functioning and well-being. We set out to build a conceptual framework of issues descriptive of burden of treatment from the perspective of the complex patient, as a first step in the development of a new patient-reported measure.
  
  
  METHODS
  We conducted semistructured interviews with patients seeking medication therapy management services at a large, academic medical center. All patients had a complex regimen of self-care (including polypharmacy), and were coping with one or more chronic health conditions. We used framework analysis to identify and code themes and subthemes. A conceptual framework of burden of treatment was outlined from emergent themes and subthemes.
  
  
  RESULTS
  Thirty-two patients (20 female, 12 male, age 26-85 years) were interviewed. Three broad themes of burden of treatment emerged including: the work patients must do to care for their health; problem-focused strategies and tools to facilitate the work of self-care; and factors that exacerbate the burden felt. The latter theme encompasses six subthemes including challenges with taking medication, emotional problems with others, role and activity limitations, financial challenges, confusion about medical information, and health care delivery obstacles.
  
  
  CONCLUSIONS
  We identified several key domains and issues of burden of treatment amenable to future measurement and organized them into a conceptual framework. Further development work on this conceptual framework will inform the derivation of a patient-reported measure of burden of treatment.
authors.affiliation: Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA;
authors.forename: David T
authors.initials: DT
authors.lastname: Eton
authors.forename: Djenane
authors.initials: D
authors.lastname: Ramalho de Oliveira
authors.forename: Jason S
authors.initials: JS
authors.lastname: Egginton
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Ridgeway
authors.forename: Laura
authors.initials: L
authors.lastname: Odell
authors.forename: Carl R
authors.initials: CR
authors.lastname: May
authors.forename: Victor M
authors.initials: VM
authors.lastname: Montori