title: Factors that lessen the burden of treatment in complex patients with chronic conditions: a qualitative study.
abstract: OBJECTIVE
  Patients with multiple chronic conditions (multimorbidity) often require ongoing treatment and complex self-care. This workload and its impact on patient functioning and well-being are, together, known as treatment burden. This study reports on factors that patients with multimorbidity draw on to lessen perceptions of treatment burden.
  
  
  METHODS
  Interviews (n=50) and focus groups (n=4 groups, five to eight participants per group) were conducted with patients receiving care in a large academic medical center or an urban safety-net hospital. Interview data were analyzed using qualitative framework analysis methods, and themes and subthemes were used to identify factors that mitigate burden. Focus groups were held to confirm these findings and clarify any new issues. This study was part of a larger program to develop a patient-reported measure of treatment burden.
  
  
  RESULTS
  Five major themes emerged from the interview data. These included: 1) problem-focused strategies, like routinizing self-care, enlisting support of others, planning for the future, and using technology; 2) emotion-focused coping strategies, like maintaining a positive attitude, focusing on other life priorities, and spirituality/faith; 3) questioning the notion of treatment burden as a function of adapting to self-care and comparing oneself to others; 4) social support (informational, tangible, and emotional assistance); and 5) positive aspects of health care, like coordination of care and beneficial relationships with providers. Additional subthemes arising from focus groups included preserving autonomy/independence and being proactive with providers.
  
  
  CONCLUSIONS
  Patients attempt to lessen the experience of treatment burden using a variety of personal, social, and health care resources. Assessing these factors in tandem with patient perceptions of treatment burden can provide a more complete picture of how patients fit complex self-care into their daily lives.
authors.affiliation: The Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA ; Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Ridgeway
authors.affiliation: The Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA ; Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
authors.forename: Jason S
authors.initials: JS
authors.lastname: Egginton
authors.affiliation: Department of Anthropology, Université Lumière Lyon 2, Lyon, France.
authors.forename: Kristina
authors.initials: K
authors.lastname: Tiedje
authors.affiliation: Division of General Internal Medicine, Hennepin County Medical Center, Minneapolis, MN, USA ; University of Minnesota Medical School, Minneapolis, MN, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Linzer
authors.affiliation: Division of General Internal Medicine, Hennepin County Medical Center, Minneapolis, MN, USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Boehm
authors.affiliation: Minneapolis Medical Research Foundation, Minneapolis, MN, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Poplau
authors.affiliation: Department of Social Pharmacy, Universidade Federal de Minas Gerais, Brazil.
authors.forename: Djenane Ramalho
authors.initials: DR
authors.lastname: de Oliveira
authors.affiliation: Pharmacy Services, Rochester, MN, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Odell
authors.affiliation: Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA ; Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.
authors.forename: Victor M
authors.initials: VM
authors.lastname: Montori
authors.affiliation: The Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA ; 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
keywords: adherence; minimally disruptive medicine; patient preferences; patient-centered