Academic journal article Canadian Journal of Sociology

Prioritizing Illness: Lessons in Self-Managing Multiple Chronic Diseases

Academic journal article Canadian Journal of Sociology

Prioritizing Illness: Lessons in Self-Managing Multiple Chronic Diseases

Article excerpt

Introduction

Chronic disease is now the leading cause of death in developed countries. The burden of chronic illness is magnified because many chronic conditions often occur as comorbidities (Bayliss et al. 2003), which is linked with increased mortality and use of health services, decreased quality of life, and patient's ability to self-manage their health (Childs 2007; Gately et al. 2007). Although health professionals offer advice and support, most of the burden of managing multiple chronic illnesses falls on patients and their families (Kerr et al. 2007).

Disease management strategies are often based on single disease models or chronic disease generally (Barlow et al. 2005), yet patients often need to manage multiple conditions simultaneously. Relatively little is known about how patients self-manage multiple chronic conditions and especially how they prioritize which of their health problems will be given the greatest attention (Childs 2007; Kerr et al. 2007). Developing a better understanding of how patients self-manage and prioritize comorbid conditions can offer insight into how disease management strategies might more effectively incorporate comorbidity. This study adds to the sociology of health care literature by building on Bury's (1982) concept of "biographical disruption" and Corbin and Strauss's "chronic illness trajectory" and examining the extent to which they apply to patients managing multiple chronic conditions.

The Self-management of Chronic Disease

Self-care is a major component of chronic disease management because the majority of illness management takes place outside of formal care (Gately et al. 2007). Having multiple chronic illnesses can influence a patient's ability to self-manage their health (Childs 2007; Lindsay 2008). Although little is known about the process of self-managing multiple chronic illnesses, several studies have examined the barriers that patients experience in doing so. For example, barriers often include interaction effects of conditions and medications (Bayliss et al. 2003), difficulty following recommended exercise and dietary plans (Krein et al. 2005), depression, fatigue, poor communication with physicians, lack of social support, pain and physical symptoms, financial problems, lack of awareness, and transportation problems (Jerant et al. 2005). The burden for self-management is heavy for people with multiple chronic conditions.

The number of chronic diseases a person has is often linked with the presence and severity of disability. Thus, comorbidities can have a profound impact on a patient's ability to manage health problems (Piette and Kerr 2006). For example, depression and arthritis can hinder a patient's functioning and even pose barriers to lifestyle change (Krein et al. 2005). Comorbid conditions may create competing demands on a patients' self-management resources (Kerr et al. 2007), yet little is known about how patients prioritize what illness they focus their greatest attention on.

Past studies focus on counts of diagnoses as a means of capturing the effects of comorbidity (Piette and Kerr 2006). Limitations with this approach are the assumptions that all comorbid conditions have a similar effect and that patients manage according to the number of conditions that they have. Although such approaches can capture the overall burden of illness (Piette and Kerr 2006), they cannot identify how patients manage and prioritize their illnesses. Understanding how patients prioritize their health may provide insight into their adherence to self-management tasks and disease-specific interventions (Piette and Kerr 2006).

Theoretical Approach

The link between health and adaptation to multiple chronic illnesses can be understood through the constructs of Corbin and Strauss's chronic illness trajectory model along with Bury's concept of biographical disruption. Some sociologists have used the concept of "illness career" to portray the continuum of health care (Goffman 1961; Hughes 1971). …

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