title: Pursuing minimally disruptive medicine: disruption from illness and health care-related demands is correlated with patient capacity.
abstract: Chronic conditions burden patients with illness and treatments. We know little about the disruption of life by the work of dialysis in relation to the resources patients can mobilize, that is, their capacity, to deal with such demands. We sought to determine the disruption of life by dialysis and its relation to patient capacity to cope.
  
  
  
  We administered a survey to 137 patients on dialysis at an academic medical center. We captured disruption from illness and treatment, and physical, mental, personal, social, financial, and environmental aspects of patient capacity using validated scales. Covariates included number of prescriptions, hours spent on health care, existence of dependents, age, sex, and income level.
  
  
  
  On average, patients reported levels of capacity and disruption comparable to published levels. In multivariate regression models, limited physical, financial, and mental capacity were significantly associated with greater disruption. Patients in the top quartile of disruption had lower-than-expected physical, financial, and mental capacity.
  
  
  
  Our sample generally had capacity comparable to other populations and may be able to meet the demands imposed by treatment. Those with reduced physical, financial, and mental capacity reported higher disruption and represent a vulnerable group that may benefit from innovations in minimally disruptive medicine.
authors.affiliation: Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, USA. Electronic address: Boehmer.Kasey@mayo.edu.
authors.forename: Kasey R
authors.initials: KR
authors.lastname: Boehmer
authors.affiliation: Division of Health Policy and Management, School of Public Health, Mayo Mail Code 197, 420 Delaware St. S.E., Minneapolis, MN, USA.
authors.forename: Nathan D
authors.initials: ND
authors.lastname: Shippee
authors.affiliation: Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, USA; Department of Health Science Research, Mayo Clinic, 200 First Street SW, Rochester, MN, USA.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Beebe
authors.affiliation: Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, USA.
authors.forename: Victor M
authors.initials: VM
authors.lastname: Montori
mesh_terms: D001294:Attitude to Health; D002908:Chronic Disease; D005260:Female; D019538:Health Care Surveys / Q000379:methods* / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015146:Midwestern United States / Q000453:epidemiology; D011788:Quality of Life / Q000523:psychology*; D006435:Renal Dialysis / Q000379:methods / Q000523:psychology* / Q000706:statistics & numerical data; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D015203:Reproducibility of Results
keywords: Chronic care; Dialysis; End-stage renal disease; Minimally disruptive medicine; Patient-centered care