Collaborative Self-Management Support in Chronic Conditions - Qualitative Study

Collaborative Self-Management Support in Chronic Conditions: a Qualitative Study of Patients', Caregivers' and Health Care Professionals' Views and Experiences of Integrated Care in Asthma, Breast Cancer and Stroke

The management of chronic conditions is a challenge for health systems worldwide, particularly in the context of an aging population, and requires urgent improvement of health services. Integrated care and patient empowerment represent promising solutions: offering tailored self-management support in a collaborative framework led to good results in several clinical contexts. Yet, large scale implementation remains a challenge. An important limitation of existing solutions is a lack of utilization of behavioural and communication theory for identifying the dynamics of pluridisciplinary collaboration and the interactive effects of the activities performed by several actors involved in self-management support in a given chronic condition. A second limitation is not involving all relevant actors in the development of health service improvement solutions, which leads to limited programme adoption and sustainability in routine care.

This study is part of a project that proposes to address these limitations and develop and interdisciplinary model of collaborative care in the self-management of chronic conditions (CoSMaS) that adopts a community-based participative approach. CoSMaS-ql is a qualitative study that will consist of semi-structured interviews with several types of stakeholders: patients, caregivers, and health care professionals of different specialties (e.g. general practitioners, nurses, specialist consultants, pharmacists). The main objective of the study is to explore the experiences and of patients, caregivers, and HCPs on how self-management support is currently delivered in asthma, cancer and stroke (content, communication, organisation of care), their needs related to self-management support provision, and envisaged solutions for improving current practice. Three different chronic conditions will be targeted: asthma, breast cancer and stroke. The qualitative data will be analysed via grounded-theory and template analysis. It will inform the development of a theoretical model of collaborative self-management support in chronic conditions. It will also result in three profiles describing 'real' versus 'ideal' care processes, which will represent needs assessment stages for future health services improvement interventions in the three conditions.

PATIENTS

Inclusion Criteria:

• having (had) one of the health conditions targeted.
• age >18 years (in order to have had the opportunity to achieve full transition from parent/caregiver-managed to self-managed care),
• at least 1 year since diagnosis (in order to have had sufficient time to experience adjustments to their condition on the long term), and
• at least 1 consultation with an HCP of any specialty in the past year (in order to ensure minimum 1 recent experience of care they could reflect on).

Exclusion Criteria:

• unable to communicate in French
• level of severity of health condition or comorbidities making participation in the study too burdensome

CAREGIVERS:

Inclusion Criteria:

- nominated by a participating patients as principal caregiver

Exclusion Criteria:

- none

HEALTH CARE PROFESSIONALS :

Inclusion Criteria:

- at least 1 year of experience working in one of the 3 chronic conditions targeted (irrespective of the number of patients consulted)

Exclusion Criteria:

- none