title: Rethinking the patient: using Burden of Treatment Theory to understand the changing dynamics of illness.
abstract: BACKGROUND
  In this article we outline Burden of Treatment Theory, a new model of the relationship between sick people, their social networks, and healthcare services. Health services face the challenge of growing populations with long-term and life-limiting conditions, they have responded to this by delegating to sick people and their networks routine work aimed at managing symptoms, and at retarding - and sometimes preventing - disease progression. This is the new proactive work of patient-hood for which patients are increasingly accountable: founded on ideas about self-care, self-empowerment, and self-actualization, and on new technologies and treatment modalities which can be shifted from the clinic into the community. These place new demands on sick people, which they may experience as burdens of treatment.
  
  
  CONCLUSIONS
  As the burdens accumulate some patients are overwhelmed, and the consequences are likely to be poor healthcare outcomes for individual patients, increasing strain on caregivers, and rising demand and costs of healthcare services. In the face of these challenges we need to better understand the resources that patients draw upon as they respond to the demands of both burdens of illness and burdens of treatment, and the ways that resources interact with healthcare utilization.
  
  
  CONCLUSIONS
  Burden of Treatment Theory is oriented to understanding how capacity for action interacts with the work that stems from healthcare. Burden of Treatment Theory is a structural model that focuses on the work that patients and their networks do. It thus helps us understand variations in healthcare utilization and adherence in different healthcare settings and clinical contexts.
authors: Faculty of Health Sciences, University of Southampton, Building 67 (Nightingale), University Road, Highfield, Southampton SO17 1BJ, UK. c.r.may@soton.ac.uk.
authors: Carl R
authors: CR
authors: May
authors: David T
authors: DT
authors: Eton
authors: Kasey
authors: K
authors: Boehmer
authors: Katie
authors: K
authors: Gallacher
authors: Katherine
authors: K
authors: Hunt
authors: Sara
authors: S
authors: MacDonald
authors: Frances S
authors: FS
authors: Mair
authors: Christine M
authors: CM
authors: May
authors: Victor M
authors: VM
authors: Montori
authors: Alison
authors: A
authors: Richardson
authors: Anne E
authors: AE
authors: Rogers
authors: Nathan
authors: N
authors: Shippee
mesh_terms: D017281:Cost of Illness; D018450:Disease Progression; D006296:Health Services; D006801:Humans; D008962:Models, Theoretical; D012648:Self Care; D012944:Social Support