TY - JOUR
T1 - Factors influencing self-management priority setting and decision-making among Chinese patients with acute coronary syndrome and type 2 diabetes mellitus
AU - Liu, Xian Liang
AU - Willis, Karen
AU - Fulbrook, Paul
AU - Wu, Chiung Jung
AU - Shi, Yan
AU - Johnson, Maree
N1 - Funding Information:
The authors would like to thank the participants of this study as well as the staff at the research site for their support and collaboration. The authors? contributions were as follows: Study conception and design: X-LL, MJ, KW, PF, C-JW, YS. Data collection: X-LL, YS. Data analysis: X-LL, MJ, KW, PF, C-JW, YS. Manuscript drafts and revisions: X-LL, MJ, PF, KW, C-JW, YS. ICMJE criteria for authorship read and met: X-LL, KW, PF, C-JW, YS, MJ. Agree with manuscript results and conclusions: X-LL, KW, PF, C-JW, YS, MJ. All authors approved the final manuscript and act as guarantors for the study, the named authors meet the international committee of medical journal editors (ICMJE) criteria for authorship. The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. The first author is a recipient of an Australian Catholic University Faculty of Health Sciences Tongji University Cotutelle PhD Scholarship.
Publisher Copyright:
© The European Society of Cardiology 2019.
Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2019/12/1
Y1 - 2019/12/1
N2 - Background: Priority setting and decision-making in relation to self-management of multiple conditions is particularly challenging for both patients and health professionals. The aim of this study was to validate a conceptual model of self-management priority setting and decision-making in multimorbidity and confirm factors that influence self-management prioritizing and decision-making in a sample of patients with acute coronary syndrome and type 2 diabetes mellitus. Methods: This was a qualitative study using deductive directed content analysis. A purposive sample of 21 participants with acute coronary syndrome and type 2 diabetes mellitus that were admitted to a Shanghai hospital were interviewed. Results: Participants provided evidence to confirm all but one of the factors from the conceptual model. Internal factors influencing self-management predominated. Agreement with recommended treatment, functional capacity and perceived synergies, antagonistic effects, or interactions among the conditions and prescribed treatments, was emphasized. The facilitators and barriers to priority setting and decision-making were related to available resources, provider communication and, to a lesser extent, confusion about recommendations, and treatment complexity. Some participants were also concerned about treatment side effects. Conclusions: Internal factors (personal beliefs, preferences, and attitudes) and facilitators and barriers (knowledge, finances, social support, and transportation) were related to changes in priority setting and decision-making and self-management behavior in this sample. Health education, which includes case studies with shifting self-management priorities is recommended, rather than a unique disease-specific focus. Further research, exploring the relationship between these factors and changes in the dominant condition and related management, using valid and reliable instruments that capture these key factors, is recommended.
AB - Background: Priority setting and decision-making in relation to self-management of multiple conditions is particularly challenging for both patients and health professionals. The aim of this study was to validate a conceptual model of self-management priority setting and decision-making in multimorbidity and confirm factors that influence self-management prioritizing and decision-making in a sample of patients with acute coronary syndrome and type 2 diabetes mellitus. Methods: This was a qualitative study using deductive directed content analysis. A purposive sample of 21 participants with acute coronary syndrome and type 2 diabetes mellitus that were admitted to a Shanghai hospital were interviewed. Results: Participants provided evidence to confirm all but one of the factors from the conceptual model. Internal factors influencing self-management predominated. Agreement with recommended treatment, functional capacity and perceived synergies, antagonistic effects, or interactions among the conditions and prescribed treatments, was emphasized. The facilitators and barriers to priority setting and decision-making were related to available resources, provider communication and, to a lesser extent, confusion about recommendations, and treatment complexity. Some participants were also concerned about treatment side effects. Conclusions: Internal factors (personal beliefs, preferences, and attitudes) and facilitators and barriers (knowledge, finances, social support, and transportation) were related to changes in priority setting and decision-making and self-management behavior in this sample. Health education, which includes case studies with shifting self-management priorities is recommended, rather than a unique disease-specific focus. Further research, exploring the relationship between these factors and changes in the dominant condition and related management, using valid and reliable instruments that capture these key factors, is recommended.
KW - Acute coronary syndrome
KW - Chinese
KW - decision-making
KW - priority setting
KW - qualitative research
KW - self-management
KW - type 2 diabetes mellitus
UR - http://www.scopus.com/inward/record.url?scp=85069864606&partnerID=8YFLogxK
U2 - 10.1177/1474515119863178
DO - 10.1177/1474515119863178
M3 - Article
C2 - 31319694
AN - SCOPUS:85069864606
VL - 18
SP - 700
EP - 710
JO - European Journal of Cardiovascular Nursing
JF - European Journal of Cardiovascular Nursing
SN - 1474-5151
IS - 8
ER -