Self-management support? Listening to people with complex co-morbidities

Area of Science:

• Health Services Research
• Chronic Disease Management
• Palliative Care

Background:

• The dominant self-management approach to long-term condition care may not suit all patients, particularly those with complex co-morbidities.
• New Zealand's healthcare system heavily emphasizes self-management, reinforced by funding mechanisms, irrespective of disease stage.

Purpose of the Study:

• To explore the experiences of individuals with complex, established co-morbidities receiving long-term condition care in New Zealand.
• To identify potential alternative care models that better address the needs of patients with advanced, multiple long-term conditions.

Main Methods:

• A multiple case study design involving 16 participants with several long-term conditions.
• Data collection included semi-structured interviews, regular patient contact over 18 months, and interviews with primary healthcare clinicians.

Main Results:

• Participants reported feeling overwhelmed and lacking the energy to engage effectively with the demanding self-management approach.
• Patients identified aspects of care outside the self-management framework that met their needs, aligning with palliative care concepts.

Conclusions:

• The current self-management model is insufficient for individuals with complex, advanced long-term conditions.
• An integrated care approach incorporating palliative care principles could provide more compassionate and effective support.
• Further research is needed to assess the acceptability of a palliative care-informed approach for this population.