title: Challenges of self-management when living with multiple chronic conditions: systematic review of the qualitative literature.
abstract: OBJECTIVE
  To explore the perspectives of patients who live with multiple chronic conditions as they relate to the challenges of self-management.
  
  
  METHODS
  On September 30, 2013, we searched MEDLINE, EMBASE, and CINAHL using relevant key words including chronic disease, comorbidity, multimorbidity, multiple chronic conditions, self-care, self-management, perspective, and perception.
  
  
  METHODS
  Three reviewers assessed and extracted the data from the included studies after study quality was rated. Qualitative thematic synthesis method was then used to identify common themes. Twenty-three articles met the inclusion criteria, with most coming from the United States.
  
  
  RESULTS
  Important themes raised by people living with multiple chronic conditions related to their ability to self-manage included living with undesirable physical and emotional symptoms, with pain and depression highlighted. Issues with conflicting knowledge, access to care, and communication with health care providers were raised. The use of cognitive strategies, including reframing, prioritizing, and changing beliefs, was reported to improve people's ability to self-manage their multiple chronic conditions.
  
  
  CONCLUSIONS
  This study provides a unique view into patients' perspectives of living with multiple chronic conditions, which are clearly linked to common functional challenges as opposed to specific diseases. Future policy and programming in self-management support should be better aligned with patients' perspectives on living with multiple chronic conditions. This might be achieved by ensuring a more patient-centred approach is adopted by providers and health service organizations.
authors: Clare
authors: C
authors: Liddy
authors: Valerie
authors: V
authors: Blazkho
authors: Karina
authors: K
authors: Mill
mesh_terms: D002908:Chronic Disease / Q000523:psychology* / Q000628:therapy; D003142:Communication; D015897:Comorbidity; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D036301:Qualitative Research; D011788:Quality of Life; D012648:Self Care / Q000523:psychology*
references: J Health Serv Res Policy. 2005 Jan;10(1):45-53
references: 15667704
references: J Card Fail. 2011 May;17(5):413-9
references: 21549299
references: Aust New Zealand Health Policy. 2009 Sep 08;6:22
references: 19735576
references: Qual Health Res. 2011 May;21(5):601-11
references: 21263063
references: Ann Fam Med. 2003 May-Jun;1(1):15-21
references: 15043175
references: Health Expect. 2005 Mar;8(1):54-63
references: 15713171
references: BMJ. 2012;345:e5205
references: 22945950
references: Prof Case Manag. 2011 Jan-Feb;16(1):6-15; quiz 16-7
references: 21164328
references: J Clin Nurs. 2008 Apr;17(7B):177-87
references: 18578794
references: J Health Care Poor Underserved. 2009 Feb;20(1):134-51
references: 19202253
references: Diabet Med. 2011 Jul;28(7):781-4
references: 21395674
references: Am J Kidney Dis. 2010 Sep;56(3):547-57
references: 20430501
references: Ann Fam Med. 2005 May-Jun;3(3):223-8
references: 15928225
references: BMC Med Res Methodol. 2013;13:10
references: 23356353
references: JAMA. 1996 Nov 13;276(18):1473-9
references: 8903258
references: BMC Med Res Methodol. 2008;8:45
references: 18616818
references: Chronic Illn. 2009 Jun;5(2):92-102
references: 19474232
references: Ann Fam Med. 2007 Sep-Oct;5(5):395-402
references: 17893380
references: BMC Fam Pract. 2012;13:65
references: 22748018
references: West J Nurs Res. 2009 Aug;31(5):627-47
references: 19390053
references: BMJ. 2007 Jun 16;334(7606):1254-6
references: 17569933
references: J Cross Cult Gerontol. 2008 Dec;23(4):377-99
references: 18987966
references: J Transcult Nurs. 2006 Apr;17(2):139-47
references: 16595401
references: BMC Health Serv Res. 2014;14:198
references: 24885135
references: Br J Gen Pract. 2012 Apr;62(597):e297-307
references: 22520918
references: J Gen Intern Med. 2007 Dec;22 Suppl 3:419-24
references: 18026811
references: Am J Health Promot. 2008 May-Jun;22(5):342-9
references: 18517095
references: Heart Lung. 2009 Sep-Oct;38(5):410-8
references: 19755191
references: BMJ. 2003 Oct 11;327(7419):837
references: 14551097
references: Chronic Illn. 2011 Jun;7(2):147-61
references: 21343220
references: Milbank Q. 1996;74(4):511-44
references: 8941260
references: Can J Diabetes. 2013 Aug;37(4):254-9
references: 24070890
references: Ann Fam Med. 2011 Mar-Apr;9(2):155-64
references: 21403143
references: Fam Pract. 2008 Aug;25(4):287-93
references: 18628243
references: Healthc Q. 2008;11(3):70-6
references: 18536538
references: Pain Med. 2009 Oct;10(7):1280-90
references: 19818038
references: Fam Pract. 2008 Jun;25(3):168-75
references: 18448858
references: Diabetes Educ. 2013 Sep-Oct;39(5):655-63
references: 23782621
references: Soc Sci Med. 2000 Oct;51(7):1087-110
references: 11005395
references: J Health Care Poor Underserved. 2011 Aug;22(3):756-71
references: 21841277
references: Health Care Women Int. 2005 Sep;26(8):672-92
references: 16234211
references: Arthritis Care Res (Hoboken). 2012 Feb;64(2):280-6
references: 21972150
references: Chronic Illn. 2010 Dec;6(4):282-93
references: 20921036
references: BMJ. 2000 Feb 26;320(7234):526-7
references: 10688539