title: Exploring patient priorities among long-term conditions in multimorbidity: A qualitative secondary analysis.
abstract: OBJECTIVE
  A lack of agreement between health-care providers and patient priorities can impact the health-care provider-patient relationship, treatment concordance and potentially health outcomes. Evidence suggests that people living with multiple morbidities do prioritise among their long-term conditions. However, the evidence revealing the underlying reasons behind this prioritisation remains limited. Given the potential implications for day-to-day self-management activity and ultimately patient outcomes, this study aims to explore how and why people with multimorbidity prioritise some long-term conditions over others and what the potential implications may be for self-management activity, and in turn, suggest how such information may help clinicians negotiate the management of multimorbidity patients.
  
  
  METHODS
  A secondary analysis of qualitative data was conducted utilising four existing data sets collated from the three research centres involved. Purposive sampling provided a sample of 41 participants who had multimorbidity. The research team collectively coded and analysed the data thematically.
  
  
  RESULTS
  All participants, except two, identified one 'main' priority long-term condition. Current priorities were arrived at by participants making comparisons between their long-term conditions, specifically by trading off the various attributes, impacts and perceived consequences of their individual long-term conditions. Two main themes emerged as to why participants identified a particular main long-term condition: (a) proximate issues surrounding barriers to functional health and (b) prioritisation of long-term conditions perceived to have a particular future risk.
  
  
  CONCLUSIONS
  The recent focus on multimorbidity within the medical literature reflects its prevalence. It is therefore important to understand the complexities of the multimorbidity illness experience. We have added to the limited literature on condition prioritisation by revealing some novel understandings of the process of condition prioritisation which can feed into patient-provider consultations in order to allow better communication and treatment planning as well as, ultimately, optimise patient outcomes.
authors.affiliation: NIHR School for Primary Care Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
authors.forename: Sudeh
authors.initials: S
authors.lastname: Cheraghi-Sohi
authors.affiliation: Arthritis Research UK, Primary Care Centre, Keele University, Staffordshire, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Morden
authors.affiliation: NIHR School for Primary Care Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Bower
authors.affiliation: Faculty of Health Sciences, University of Southampton, Southampton, UK.
authors.forename: Anne
authors.initials: A
authors.lastname: Kennedy
authors.affiliation: Faculty of Health Sciences, University of Southampton, Southampton, UK.
authors.forename: Anne
authors.initials: A
authors.lastname: Rogers
authors.affiliation: Arthritis Research UK, Primary Care Centre, Keele University, Staffordshire, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Richardson
authors.affiliation: Arthritis Research UK, Primary Care Centre, Keele University, Staffordshire, UK.
authors.forename: Tom
authors.initials: T
authors.lastname: Sanders
authors.affiliation: Research Department of Primary Care and Population Health, University College London, London, UK.
authors.forename: Fiona
authors.initials: F
authors.lastname: Stevenson
authors.affiliation: Arthritis Research UK, Primary Care Centre, Keele University, Staffordshire, UK.
authors.forename: Bie N
authors.initials: BN
authors.lastname: Ong
keywords: Multimorbidity; primary care; priorities; risk; self-management