title: Taxonomy of the burden of treatment: a multi-country web-based qualitative study of patients with chronic conditions.
abstract: BACKGROUND
  Management strategies for patients with chronic conditions are becoming increasingly complex, which may result in a burden of treatment for patients. To develop a Minimally Disruptive Medicine designed to reduce the burden of treatment, clinicians need to understand which healthcare tasks and aggravating factors may be responsible for this burden. The objective of the present study was to describe and classify the components of the burden of treatment for patients with chronic conditions from the patient's perspective.
  
  
  METHODS
  We performed a multi-country qualitative study using an online survey and a purposive sampling strategy to select English-, French-, and Spanish-speaking participants with different chronic conditions. Participants were recruited by physicians, patients' associations, advertisement on social media, and 'snowballing'. The answers were analyzed by i) manual content analysis with a grounded theory approach, coded by two researchers, and ii) automatic textual analysis by Reinert's method.
  
  
  RESULTS
  Between 2013 and 2014, 1,053 participants from 34 different countries completed the online survey using 408,625 words. Results from both analyses were synthesized in a taxonomy of the burden of treatment, which described i) the tasks imposed on patients by their diseases and by their healthcare system (e.g., medication management, lifestyle changes, follow-up, etc.); ii) the structural (e.g., access to healthcare resources, coordination between care providers), personal, situational, and financial factors that aggravated the burden of treatment; and iii) patient-reported consequences of the burden (e.g., poor adherence to treatments, financial burden, impact on professional, family, and social life, etc.). Our findings may not be applicable to patients with chronic conditions who differ from those who responded to our survey.
  
  
  CONCLUSIONS
  Our taxonomy of the burden of treatment, provided by patients with chronic conditions from different countries and settings, supports the development of tools to ascertain the burden of treatment and highlights potential targets for interventions to minimize it.
authors.affiliation: Department of General Medicine, Paris Diderot University, 16 rue Henri Huchard, 75018, Paris, France. thi.tran-viet@htd.aphp.fr.|Centre de Recherche en Epidémiologie et Statistiques, INSERM U1153, 1 place du Parvis Notre Dame, 75004, Paris, France. thi.tran-viet@htd.aphp.fr.|Centre d'Épidémiologie Clinique, Hôpital Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, 1 place du Parvis Notre Dame, 75004, Paris, France. thi.tran-viet@htd.aphp.fr.
authors.forename: Viet-Thi
authors.initials: VT
authors.lastname: Tran
authors.affiliation: Paris Descartes University, 12 Rue de l'Ecole de Médecine, 75006, Paris, France. caroline.grace.barnes@gmail.com.
authors.forename: Caroline
authors.initials: C
authors.lastname: Barnes
authors.affiliation: Division of Health Care and Policy Research, Department of Health Sciences Research and Knowledge and Evaluation Research Unit, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA. montori.victor@mayo.edu.
authors.forename: Victor M
authors.initials: VM
authors.lastname: Montori
authors.affiliation: Paris Sud University, 15 Rue Georges Clemenceau, 91400, Orsay, France. bruno.falissard@gmail.com.|INSERM U669, 97 Boulevard de Port Royal, 75679, Paris, France. bruno.falissard@gmail.com.
authors.forename: Bruno
authors.initials: B
authors.lastname: Falissard
authors.affiliation: Centre de Recherche en Epidémiologie et Statistiques, INSERM U1153, 1 place du Parvis Notre Dame, 75004, Paris, France. philippe.ravaud@htd.aphp.fr.|Centre d'Épidémiologie Clinique, Hôpital Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, 1 place du Parvis Notre Dame, 75004, Paris, France. philippe.ravaud@htd.aphp.fr.|Paris Descartes University, 12 Rue de l'Ecole de Médecine, 75006, Paris, France. philippe.ravaud@htd.aphp.fr.|Department of Epidemiology, Columbia University Mailman School of Public Health, 116th St & Broadway, New York, NY, 10027, USA. philippe.ravaud@htd.aphp.fr.
authors.forename: Philippe
authors.initials: P
authors.lastname: Ravaud
mesh_terms: D002908:Chronic Disease / Q000628:therapy*; D017281:Cost of Illness; D003625:Data Collection; D003695:Delivery of Health Care; D019468:Disease Management; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research