PDF(Pubmed)
Abstract：
OBJECTIVE: To elicit experiences of patients, family caregivers, and healthcare professionals in intermediate care units (IMCUs) in an academic medical centre in Baltimore, MD related to the challenges and intricacies of multimorbidity management to inform development of a multimorbidity symptom management toolkit.
METHODS: Experience-based co-design.
METHODS: Between July and October 2021, patients aged 55 years and older with multimorbidity admitted to IMCUs at an academic medical centre in Baltimore, Maryland, USA were recruited and interviewed in person. Interdisciplinary healthcare professionals working in the IMCU were interviewed virtually. Participants were asked questions about their role in recognizing and treating symptoms, factors affecting the quality of life, symptom burden and trajectory over time, and strategies that have and have not worked for managing symptoms. An inductive thematic analysis approach was used for analysis.
RESULTS: Twenty-three interviews were conducted: 9 patients, 2 family caregivers, and 12 healthcare professionals. Patients\' mean age was 67.5 (±6.5) years, over half (n = 5) were Black or Hispanic, and the average number of comorbidities was 3.67. Five major themes that affect symptom management emerged: (1) the patient-provider relationship; (2) open and honest communication; (3) accessibility of resources during hospitalization and at discharge; (4) caregiver support, training, and education; and (5) care coordination and follow-up care.
CONCLUSIONS: Patients, caregivers, and healthcare professionals often have similar goals but different priorities for multimorbidity management. It is imperative to identify shared priorities and target holistic interventions that consider patient and caregiver experiences to improve outcomes.
UNASSIGNED: This paper addresses the paucity of research related to the shared experience of disease trajectory and symptom management for people living with multimorbidity. We found that patients, caregivers, and healthcare professionals often have similar goals but different care and communication priorities. Understanding differing priorities will help better design interventions to support symptom management so people with multimorbidity can have the best possible quality of life.
UNASSIGNED: We have adhered to the Consolidated Criteria for Reporting Qualitative Studies (COREQ) guidelines in our reporting.
UNASSIGNED: This study has been designed and implemented with patient and public involvement throughout the process, including community advisory board engagement in the project proposal phase and interview guide development, and member checking in the data collection and analysis phases. The method we chose, experience-based co-design, emphasizes the importance of engaging members of a community to act as experts in their own life challenges. In the coming phases of the study, the public will be involved in developing and testing a new intervention, informed by these qualitative interviews and co-design events, to support symptom management for people with multimorbidity.
METHODS: Experience-based co-design.
METHODS: Between July and October 2021, patients aged 55 years and older with multimorbidity admitted to IMCUs at an academic medical centre in Baltimore, Maryland, USA were recruited and interviewed in person. Interdisciplinary healthcare professionals working in the IMCU were interviewed virtually. Participants were asked questions about their role in recognizing and treating symptoms, factors affecting the quality of life, symptom burden and trajectory over time, and strategies that have and have not worked for managing symptoms. An inductive thematic analysis approach was used for analysis.
RESULTS: Twenty-three interviews were conducted: 9 patients, 2 family caregivers, and 12 healthcare professionals. Patients\' mean age was 67.5 (±6.5) years, over half (n = 5) were Black or Hispanic, and the average number of comorbidities was 3.67. Five major themes that affect symptom management emerged: (1) the patient-provider relationship; (2) open and honest communication; (3) accessibility of resources during hospitalization and at discharge; (4) caregiver support, training, and education; and (5) care coordination and follow-up care.
CONCLUSIONS: Patients, caregivers, and healthcare professionals often have similar goals but different priorities for multimorbidity management. It is imperative to identify shared priorities and target holistic interventions that consider patient and caregiver experiences to improve outcomes.
UNASSIGNED: This paper addresses the paucity of research related to the shared experience of disease trajectory and symptom management for people living with multimorbidity. We found that patients, caregivers, and healthcare professionals often have similar goals but different care and communication priorities. Understanding differing priorities will help better design interventions to support symptom management so people with multimorbidity can have the best possible quality of life.
UNASSIGNED: We have adhered to the Consolidated Criteria for Reporting Qualitative Studies (COREQ) guidelines in our reporting.
UNASSIGNED: This study has been designed and implemented with patient and public involvement throughout the process, including community advisory board engagement in the project proposal phase and interview guide development, and member checking in the data collection and analysis phases. The method we chose, experience-based co-design, emphasizes the importance of engaging members of a community to act as experts in their own life challenges. In the coming phases of the study, the public will be involved in developing and testing a new intervention, informed by these qualitative interviews and co-design events, to support symptom management for people with multimorbidity.
摘要：
目的：为了激发患者的经验，家庭照顾者,以及巴尔的摩学术医疗中心的中级护理单位（IMCU）的医疗保健专业人员，MD与多病症管理的挑战和复杂性有关，以告知多病症症状管理工具包的开发。
方法：基于经验的协同设计。
方法：在2021年7月至10月之间，年龄在55岁及以上的多病患者在巴尔的摩的学术医疗中心接受IMCU治疗，马里兰,美国被招募并亲自面试。在IMCU工作的跨学科医疗保健专业人员几乎接受了采访。参与者被问及他们在识别和治疗症状方面的作用，影响生活质量的因素，随着时间的推移，症状负担和轨迹，以及对症状管理有效和无效的策略。采用归纳主题分析方法进行分析。
结果：进行了23次访谈：9名患者，2家庭照顾者，12名医疗保健专业人员。患者的平均年龄为67.5（±6.5）岁，超过一半（n=5）是黑人或西班牙裔，平均合并症为3.67例。出现了影响症状管理的五个主要主题：（1）患者与提供者的关系；（2）开放和诚实的沟通；（3）住院和出院期间资源的可及性；（4）护理人员支持，培训,和教育；(5)护理协调和后续护理。
结论：患者，看护者,和医疗保健专业人员通常有相似的目标，但不同的优先级的多发病率管理。必须确定共同的优先事项，并针对考虑患者和护理人员经验的整体干预措施，以改善结果。
■本文针对与多病患者的疾病轨迹和症状管理的共同经验相关的研究不足。我们发现病人,看护者,和医疗保健专业人员通常有相似的目标，但不同的护理和沟通优先级。了解不同的优先事项将有助于更好地设计干预措施以支持症状管理，从而使患有多种疾病的人可以获得最佳的生活质量。
我们在报告中遵守了定性研究报告综合标准(COREQ)指南。
■这项研究是在患者和公众参与的整个过程中设计和实施的，包括社区咨询委员会参与项目提案阶段和面试指南开发，在数据收集和分析阶段进行成员检查。我们选择的方法，基于经验的共同设计，强调让社区成员在自己的生活挑战中充当专家的重要性。在研究的未来阶段，公众将参与开发和测试新的干预措施，通过这些定性访谈和共同设计活动，支持多病患者的症状管理。
方法：基于经验的协同设计。
方法：在2021年7月至10月之间，年龄在55岁及以上的多病患者在巴尔的摩的学术医疗中心接受IMCU治疗，马里兰,美国被招募并亲自面试。在IMCU工作的跨学科医疗保健专业人员几乎接受了采访。参与者被问及他们在识别和治疗症状方面的作用，影响生活质量的因素，随着时间的推移，症状负担和轨迹，以及对症状管理有效和无效的策略。采用归纳主题分析方法进行分析。
结果：进行了23次访谈：9名患者，2家庭照顾者，12名医疗保健专业人员。患者的平均年龄为67.5（±6.5）岁，超过一半（n=5）是黑人或西班牙裔，平均合并症为3.67例。出现了影响症状管理的五个主要主题：（1）患者与提供者的关系；（2）开放和诚实的沟通；（3）住院和出院期间资源的可及性；（4）护理人员支持，培训,和教育；(5)护理协调和后续护理。
结论：患者，看护者,和医疗保健专业人员通常有相似的目标，但不同的优先级的多发病率管理。必须确定共同的优先事项，并针对考虑患者和护理人员经验的整体干预措施，以改善结果。
■本文针对与多病患者的疾病轨迹和症状管理的共同经验相关的研究不足。我们发现病人,看护者,和医疗保健专业人员通常有相似的目标，但不同的护理和沟通优先级。了解不同的优先事项将有助于更好地设计干预措施以支持症状管理，从而使患有多种疾病的人可以获得最佳的生活质量。
我们在报告中遵守了定性研究报告综合标准(COREQ)指南。
■这项研究是在患者和公众参与的整个过程中设计和实施的，包括社区咨询委员会参与项目提案阶段和面试指南开发，在数据收集和分析阶段进行成员检查。我们选择的方法，基于经验的共同设计，强调让社区成员在自己的生活挑战中充当专家的重要性。在研究的未来阶段，公众将参与开发和测试新的干预措施，通过这些定性访谈和共同设计活动，支持多病患者的症状管理。
