Treatment burden in multimorbidity: an integrative review.
Adherence
Comorbidity
Healthcare tasks
Multimorbidity
Treatment burden
Journal
BMC primary care
ISSN: 2731-4553
Titre abrégé: BMC Prim Care
Pays: England
ID NLM: 9918300889006676
Informations de publication
Date de publication:
28 Sep 2024
28 Sep 2024
Historique:
received:
13
02
2024
accepted:
28
08
2024
medline:
29
9
2024
pubmed:
29
9
2024
entrez:
28
9
2024
Statut:
epublish
Résumé
People living with multimorbidity experience increased treatment burden, which can result in poor health outcomes. Despite previous efforts to grasp the concept of treatment burden, the treatment burden of people living with multimorbidity has not been thoroughly explored, which may limit our understanding of treatment burden in this population. This study aimed to identify the components, contributing factors, and health outcomes of treatment burden in people with multiple diseases to develop an integrated map of treatment burden experienced by people living with multimorbidity. The second aim of this study is to identify the treatment burden instruments used to evaluate people living with multimorbidity and assess the comprehensiveness of the instruments. This integrative review was conducted using the electronic databases MEDLINE, EMBASE, CINAHL, and reference lists of articles through May 2023. All empirical studies published in English were included if they explored treatment burden among adult people living with multimorbidity. Data extraction using a predetermined template was performed. Thirty studies were included in this review. Treatment burden consisted of four healthcare tasks and the social, emotional, and financial impacts that these tasks imposed on people living with multimorbidity. The context of multimorbidity, individual's circumstances, and how available internal and external resources affected treatment burden. We explored that an increase in treatment burden resulted in non-adherence to treatment, disease progression, poor health status and quality of life, and caregiver burden. Three instruments were used to measure treatment burden in living with multimorbidity. The levels of comprehensiveness of the instruments regarding healthcare tasks and impacts varied. However, none of the items addressed the healthcare task of ongoing prioritization of the tasks. We developed an integrated map illustrating the relationships between treatment burden, the context of multimorbidity, people's resources, and the health outcomes. None of the existing measures included an item asking about the ongoing process of setting priorities among the various healthcare tasks, which highlights the need for improved measures. Our findings provide a deeper understanding of treatment burden in multimorbidity, but more research for refinement is needed. Future studies are also needed to develop strategies to comprehensively capture both the healthcare tasks and impacts for people living with multimorbidity and to decrease treatment burden using a holistic approach to improve relevant outcomes. DOI: https://doi.org/10.17605/OSF.IO/UF46V.
Sections du résumé
BACKGROUND
BACKGROUND
People living with multimorbidity experience increased treatment burden, which can result in poor health outcomes. Despite previous efforts to grasp the concept of treatment burden, the treatment burden of people living with multimorbidity has not been thoroughly explored, which may limit our understanding of treatment burden in this population. This study aimed to identify the components, contributing factors, and health outcomes of treatment burden in people with multiple diseases to develop an integrated map of treatment burden experienced by people living with multimorbidity. The second aim of this study is to identify the treatment burden instruments used to evaluate people living with multimorbidity and assess the comprehensiveness of the instruments.
METHODS
METHODS
This integrative review was conducted using the electronic databases MEDLINE, EMBASE, CINAHL, and reference lists of articles through May 2023. All empirical studies published in English were included if they explored treatment burden among adult people living with multimorbidity. Data extraction using a predetermined template was performed.
RESULTS
RESULTS
Thirty studies were included in this review. Treatment burden consisted of four healthcare tasks and the social, emotional, and financial impacts that these tasks imposed on people living with multimorbidity. The context of multimorbidity, individual's circumstances, and how available internal and external resources affected treatment burden. We explored that an increase in treatment burden resulted in non-adherence to treatment, disease progression, poor health status and quality of life, and caregiver burden. Three instruments were used to measure treatment burden in living with multimorbidity. The levels of comprehensiveness of the instruments regarding healthcare tasks and impacts varied. However, none of the items addressed the healthcare task of ongoing prioritization of the tasks.
CONCLUSIONS
CONCLUSIONS
We developed an integrated map illustrating the relationships between treatment burden, the context of multimorbidity, people's resources, and the health outcomes. None of the existing measures included an item asking about the ongoing process of setting priorities among the various healthcare tasks, which highlights the need for improved measures. Our findings provide a deeper understanding of treatment burden in multimorbidity, but more research for refinement is needed. Future studies are also needed to develop strategies to comprehensively capture both the healthcare tasks and impacts for people living with multimorbidity and to decrease treatment burden using a holistic approach to improve relevant outcomes.
TRIAL REGISTRATION
BACKGROUND
DOI: https://doi.org/10.17605/OSF.IO/UF46V.
Identifiants
pubmed: 39342121
doi: 10.1186/s12875-024-02586-z
pii: 10.1186/s12875-024-02586-z
doi:
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
352Subventions
Organisme : National Research Foundation of Korea grants
ID : 2021R1C1C100849812
Informations de copyright
© 2024. The Author(s).
Références
Fortin M, Stewart M, Poitras M-E, Almirall J, Maddocks H. A systematic review of prevalence studies on multimorbidity: toward a more uniform methodology. The Annals of Family Medicine. 2012;10(2):142–51.
pubmed: 22412006
doi: 10.1370/afm.1337
WHO. Multimorbidity. 2016.
Tran V-T, Montori VM, Ravaud P, editors. Is my patient Overwhelmed?: determining thresholds for acceptable burden of treatment using data from the compare e-Cohort. Mayo Clinic Proceedings; 2020: Elsevier.
Hardman R, StephenSpelten, Evelien. Multimorbidity and its effect on perceived burden, capacity and the ability to self-manage in a low-income rural primary care population: A qualitative study. PloS one. 2021;16(8):e0255802.
Corbett T, Lee K, Cummings A, Calman L, Farrington N, Lewis L, et al. Self-management by older people living with cancer and multi-morbidity: a qualitative study. Support Care Cancer. 2022;30(6):4823–33.
pubmed: 35147757
pmcid: 8831683
doi: 10.1007/s00520-022-06892-z
Fix GM, Cohn ES, Solomon JL, Cortes DE, Mueller N, Kressin NR, et al. The role of comorbidities in patients’ hypertension self-management. Chronic Illn. 2014;10(2):81–92.
pubmed: 23892774
doi: 10.1177/1742395313496591
Moffat K, Mercer SW. Challenges of managing people with multimorbidity in today’s healthcare systems. BMC Fam Pract. 2015;16(1):129.
pubmed: 26462820
pmcid: 4604728
doi: 10.1186/s12875-015-0344-4
Matima R, Murphy K, Levitt NS, BeLue R, Oni T. A qualitative study on the experiences and perspectives of public sector patients in Cape Town in managing the workload of demands of HIV and type 2 diabetes multimorbidity. PLoS ONE. 2018;13(3):e0194191.
pubmed: 29538415
pmcid: 5851623
doi: 10.1371/journal.pone.0194191
van Pinxteren M, Mbokazi N, Murphy K, Mair FS, May C, Levitt N. The impact of persistent precarity on patients’ capacity to manage their treatment burden: A comparative qualitative study between urban and rural patients with multimorbidity in South Africa. Front Med (Lausanne). 2023;10:1061190.
pubmed: 37064034
doi: 10.3389/fmed.2023.1061190
May C, Montori VM, Mair FS. We need minimally disruptive medicine. Bmj. 2009;339.
Leppin AL, Montori VM, Gionfriddo MR. Minimally Disruptive Medicine: A Pragmatically Comprehensive Model for Delivering Care to Patients with Multiple Chronic Conditions. Healthcare (Basel). 2015;3(1):50–63.
pubmed: 27417747
doi: 10.3390/healthcare3010050
Eton DT, Yost KJ, Lai JS, Ridgeway JL, Egginton JS, Rosedahl JK, et al. Development and validation of the Patient Experience with Treatment and Self-management (PETS): a patient-reported measure of treatment burden. Qual Life Res. 2017;26(2):489–503.
pubmed: 27566732
doi: 10.1007/s11136-016-1397-0
Smith SM, Bayliss EA, Mercer SW, Gunn J, Vestergaard M, Wyke S, et al. How to design and evaluate interventions to improve outcomes for patients with multimorbidity. J Comorb. 2013;3(1):10–7.
pubmed: 29090141
pmcid: 5636021
doi: 10.15256/joc.2013.3.21
Eton DT, Ramalho de Oliveira D, Egginton JS, Ridgeway JL, Odell L, May CR, et al. Building a measurement framework of burden of treatment in complex patients with chronic conditions: a qualitative study. Patient Related Outcome Measures. 2012;3:39–49.
Shippee ND, Shah ND, May CR, Mair FS, Montori VM. Cumulative complexity: a functional, patient-centered model of patient complexity can improve research and practice. J Clin Epidemiol. 2012;65(10):1041–51.
pubmed: 22910536
doi: 10.1016/j.jclinepi.2012.05.005
Rosbach M, Andersen JS. Patient-experienced burden of treatment in patients with multimorbidity – A systematic review of qualitative data. PLoS ONE. 2017;12(6):e0179916.
pubmed: 28644877
pmcid: 5482482
doi: 10.1371/journal.pone.0179916
Matthews KS, Rennoldson SC, Fraser SD. Influence of health-system change on treatment burden: a systematic review. Br J Gen Pract. 2023;73(726):e59–66.
pubmed: 36253115
doi: 10.3399/BJGP.2022.0066
Eton DT, Ridgeway JL, Egginton JS, Tiedje K, Linzer M, Boehm DH, et al. Finalizing a measurement framework for the burden of treatment in complex patients with chronic conditions. Patient Relat Outcome Meas. 2015;6:117–26.
pubmed: 25848328
pmcid: 4383147
doi: 10.2147/PROM.S78955
Tran V-T, Barnes C, Montori VM, Falissard B, Ravaud P. Taxonomy of the burden of treatment: a multi-country web-based qualitative study of patients with chronic conditions. BMC Med. 2015;13(1):115.
pubmed: 25971838
pmcid: 4446135
doi: 10.1186/s12916-015-0356-x
Demain S, Gonçalves AC, Areia C, Oliveira R, Marcos AJ, Marques A, et al. Living with, managing and minimising treatment burden in long term conditions: a systematic review of qualitative research. PLoS ONE. 2015;10(5):e0125457.
pubmed: 26024379
pmcid: 4449201
doi: 10.1371/journal.pone.0125457
Sav A, Salehi A, Mair FS, McMillan SS. Measuring the burden of treatment for chronic disease: implications of a scoping review of the literature. BMC Med Res Methodol. 2017;17:1–14.
doi: 10.1186/s12874-017-0411-8
Mendoza-Quispe D, Perez-Leon S, Alarcon-Ruiz CA, Gaspar A, Cuba-Fuentes MS, Zunt JR, et al. Scoping review of measures of treatment burden in patients with multimorbidity: advancements and current gaps. J Clin Epidemiol. 2023;159:92–105.
pubmed: 37217106
pmcid: 10529536
doi: 10.1016/j.jclinepi.2023.05.013
Lee KS, Lee J. Scoping review of treatment burden in multimorbidity: definition to interventions. OSF. 2023.
Whittemore R, Knafl K. The integrative review: updated methodology. J Adv Nurs. 2005;52(5):546–53.
pubmed: 16268861
doi: 10.1111/j.1365-2648.2005.03621.x
Sav A, King MA, Whitty JA, Kendall E, McMillan SS, Kelly F, et al. Burden of treatment for chronic illness: a concept analysis and review of the literature. Health Expect. 2015;18(3):312–24.
pubmed: 23363080
doi: 10.1111/hex.12046
Bernell S, Howard SW. Use Your Words Carefully: What Is a Chronic Disease? Front Public Health. 2016;4:159.
pubmed: 27532034
pmcid: 4969287
doi: 10.3389/fpubh.2016.00159
Ishii H, Shin K, Tosaki T, Haga T, Nakajima Y, Shiraiwa T, et al. Reproducibility and Validity of a Questionnaire Measuring Treatment Burden on Patients with Type 2 Diabetes: Diabetic Treatment Burden Questionnaire (DTBQ). Diabetes Ther. 2018;9(3):1001–19.
pubmed: 29600503
pmcid: 5984917
doi: 10.1007/s13300-018-0414-4
Pluye P, Gagnon MP, Griffiths F, Johnson-Lafleur J. A scoring system for appraising mixed methods research, and concomitantly appraising qualitative, quantitative and mixed methods primary studies in Mixed Studies Reviews. Int J Nurs Stud. 2009;46(4):529–46.
pubmed: 19233357
doi: 10.1016/j.ijnurstu.2009.01.009
Pace R, Pluye P, Bartlett G, Macaulay AC, Salsberg J, Jagosh J, et al. Testing the reliability and efficiency of the pilot Mixed Methods Appraisal Tool (MMAT) for systematic mixed studies review. Int J Nurs Stud. 2012;49(1):47–53.
pubmed: 21835406
doi: 10.1016/j.ijnurstu.2011.07.002
Hong QN, Fàbregues S, Bartlett G, Boardman F, Cargo M, Dagenais P, et al. The Mixed Methods Appraisal Tool (MMAT) version 2018 for information professionals and researchers. Educ Inf. 2018;34(4):285–91.
Eton DT, Ridgeway JL, Linzer M, Boehm DH, Rogers EA, Yost KJ, et al. Healthcare provider relational quality is associated with better self-management and less treatment burden in people with multiple chronic conditions. Patient Prefer Adherence. 2017;11:1635–46.
pubmed: 29033551
pmcid: 5630069
doi: 10.2147/PPA.S145942
Eton DT, Linzer M, Boehm DH, Vanderboom CE, Rogers EA, Frost MH, et al. Deriving and validating a brief measure of treatment burden to assess person-centered healthcare quality in primary care: a multi-method study. BMC Fam Pract. 2020;21(1):221.
pubmed: 33115421
pmcid: 7594460
doi: 10.1186/s12875-020-01291-x
Eton DT, Lee MK, St Sauver JL, Anderson RT. Known-groups validity and responsiveness to change of the Patient Experience with Treatment and Self-management (PETS vs. 2.0): a patient-reported measure of treatment burden. Qual Life Res. 2020;29(11):3143–54.
Lee MK, St Sauver JL, Anderson RT, Linzer M, Eton DT. Confirmatory Factor Analyses and Differential Item Functioning of the Patient Experience with Treatment and Self-Management (PETS vs. 2.0): A Measure of Treatment Burden. Patient Relat Outcome Meas. 2020;11:249–63.
Eton DT, Anderson RT, Cohn WF, Kennedy EM, St. Sauver JL, Bucknell BJ, et al. Risk factors for poor health-related quality of life in cancer survivors with multiple chronic conditions: exploring the role of treatment burden as a mediator. Patient Related Outcome Measures. 2019;10:89–99.
Eton DT, Anderson RT, St Sauver JL, Rogers EA, Linzer M, Lee MK. Longitudinal trajectories of treatment burden: A prospective survey study of adults living with multiple chronic conditions in the midwestern United States. J Multimorb Comorb. 2022;12:26335565221081292.
pubmed: 35586037
pmcid: 9106306
doi: 10.1177/26335565221081291
Siddiqui A, Ornstein KA, Ankuda CK. Prevalence of Treatment Burden in the Last Three Years of Life. J Palliat Med. 2020;24(6):879–86.
pubmed: 33185506
doi: 10.1089/jpm.2020.0170
Ortenblad L, Meillier L, Jonsson AR. Multi-morbidity: A patient perspective on navigating the health care system and everyday life. Chronic Illn. 2018;14(4):271–82.
pubmed: 28914088
doi: 10.1177/1742395317731607
Duguay C, Gallagher F, Fortin M. The experience of adults with multimorbidity: a qualitative study. J Comorb. 2014;4(1):11–21.
pubmed: 29090149
pmcid: 5556408
doi: 10.15256/joc.2014.4.31
Hounkpatin HO, Roderick P, Harris S, Morris JE, Smith D, Walsh B, et al. Change in treatment burden among people with multimorbidity: a follow-up survey. Br J Gen Pract. 2022;72(724):e816–24.
pubmed: 36302680
pmcid: 9466958
doi: 10.3399/BJGP.2022.0103
Morris JE, Roderick PJ, Harris S, Yao G, Crowe S, Phillips D, et al. Treatment burden for patients with multimorbidity: cross-sectional study with exploration of a single-item measure. Br J Gen Pract. 2021;71(706):e381–90.
pubmed: 33875419
pmcid: 8074644
doi: 10.3399/BJGP.2020.0883
Herzig L, Zeller A, Pasquier J, Streit S, Neuner-Jehle S, Excoffier S, et al. Factors associated with patients’ and GPs’ assessment of the burden of treatment in multimorbid patients: a cross-sectional study in primary care. BMC Fam Pract. 2019;20(1):88.
pubmed: 31253097
pmcid: 6598361
doi: 10.1186/s12875-019-0974-z
Tinetti ME, Naik AD, Dindo L, Costello DM, Esterson J, Geda M, et al. Association of patient priorities-aligned decision-making with patient outcomes and ambulatory health care burden among older adults with multiple chronic conditions: a nonrandomized clinical trial. JAMA Intern Med. 2019;179(12):1688–97.
pubmed: 31589281
pmcid: 6784811
doi: 10.1001/jamainternmed.2019.4235
McCarthy C, Clyne B, Boland F, Moriarty F, Flood M, Wallace E, et al. GP-delivered medication review of polypharmacy, deprescribing, and patient priorities in older people with multimorbidity in Irish primary care (SPPiRE Study): A cluster randomised controlled trial. PLoS Med. 2022;19(1):e1003862.
pubmed: 34986166
pmcid: 8730438
doi: 10.1371/journal.pmed.1003862
Hu X-J, Harry H. X.Li, Yu-TingWu, Xiao-YaWang, YiChen, Jia-HengWang, Jia-JiWong, Samuel Y. S.Mercer, Stewart W. Healthcare needs, experiences and treatment burden in primary care patients with multimorbidity: An evaluation of process of care from patients' perspectives. Health expectations : an international journal of public participation in health care and health policy. 2022;25(1):203–13.
Aschmann HE, Puhan MA, Robbins CW, Bayliss EA, Chan WV, Mularski RA, et al. Outcome preferences of older people with multiple chronic conditions and hypertension: a cross-sectional survey using best-worst scaling. Health Qual Life Outcomes. 2019;17(1):186.
pubmed: 31856842
pmcid: 6924040
doi: 10.1186/s12955-019-1250-6
Eton DT, Anderson RT, Cohn WF, Kennedy EM, St Sauver JL, Bucknell BJ, et al. Risk factors for poor health-related quality of life in cancer survivors with multiple chronic conditions: exploring the role of treatment burden as a mediator. Patient Relat Outcome Meas. 2019;10:89–99.
pubmed: 30962731
pmcid: 6432889
doi: 10.2147/PROM.S191480
Song M-K, Paul S, Plantinga L, Henry C, Turberville-Trujillo L. social networks of self-care and perceived treatment burden among patients on in-center hemodialysis. Kidney Medicine. 2019;1(3):97–103.
pubmed: 32734190
pmcid: 7380407
doi: 10.1016/j.xkme.2019.04.001
Hardman R, Begg S, Spelten E. Multimorbidity and its effect on perceived burden, capacity and the ability to self-manage in a low-income rural primary care population: A qualitative study. PLoS ONE. 2021;16(8):e0255802.
pubmed: 34370758
pmcid: 8351969
doi: 10.1371/journal.pone.0255802
Chin WY, Wong CKH, Ng CCW, Choi EPH, Lam CLK. Cultural adaptation and psychometric properties of the Chinese Burden of Treatment Questionnaire (C-TBQ) in primary care patients with multi-morbidity. Fam Pract. 2019;36(5):657–65.
pubmed: 30820558
doi: 10.1093/fampra/cmz008
El-Nagar SA, Nady SE, Elzyen ES, El-Saidy TMK. Relationship between Health Literacy and Treatment Burden among Patients with Multi-Morbidity. 2021.
Morgan SA, Eyles C, Roderick PJ, Adongo PB, Hill AG. Women living with multi-morbidity in the Greater Accra Region of Ghana: a qualitative study guided by the Cumulative Complexity Model. J Biosoc Sci. 2019;51(4):562–77.
pubmed: 30472965
doi: 10.1017/S0021932018000342
van Merode T, van de Ven K, van den Akker M. Patients with multimorbidity and their treatment burden in different daily life domains: a qualitative study in primary care in the Netherlands and Belgium. J Comorb. 2018;8(1):9–15.
pubmed: 29651408
pmcid: 5885066
doi: 10.15256/joc.2018.8.119
Schreiner N, Daly B. A Pilot Study Exploring Treatment Burden in a Skilled Nursing Population. Rehabilitation Nursing Journal. 2020;45(3).
Schulze J, Breckner A, Duncan P, Scherer M, Pohontsch NJ, Luhmann D. Adaptation and validation of a German version of the Multimorbidity Treatment Burden Questionnaire. Health Qual Life Outcomes. 2022;20(1):90.
pubmed: 35658972
pmcid: 9166496
doi: 10.1186/s12955-022-01993-z
Dou L, Huang J, Duncan P, Guo L. Translation, cultural adaptation and validation of the Chinese Multimorbidity Treatment Burden Questionnaire(C-MTBQ): a study of older hospital patients. Health Qual Life Outcomes. 2020;18(1):194.
pubmed: 32571343
pmcid: 7310246
doi: 10.1186/s12955-020-01395-z
Schreiner N, DiGennaro S, Harwell C, Burant C, Daly B, Douglas S. Treatment burden as a predictor of self-management adherence within the primary care population. Appl Nurs Res. 2020;54:151301.
pubmed: 32650885
doi: 10.1016/j.apnr.2020.151301
Duncan P, Murphy M, Man MS, Chaplin K, Gaunt D, Salisbury C. Development and validation of the Multimorbidity Treatment Burden Questionnaire (MTBQ). BMJ Open. 2018;8(4):e019413.
pubmed: 29654011
pmcid: 5900423
doi: 10.1136/bmjopen-2017-019413
Bratzke LC, Muehrer RJ, Kehl KA, Lee KS, Ward EC, Kwekkeboom KL. Self-management priority setting and decision-making in adults with multimorbidity: a narrative review of literature. Int J Nurs Stud. 2015;52(3):744–55.
pubmed: 25468131
doi: 10.1016/j.ijnurstu.2014.10.010
Gobeil-Lavoie AP, Chouinard MC, Danish A, Hudon C. Characteristics of self-management among patients with complex health needs: a thematic analysis review. BMJ Open. 2019;9(5):e028344.
pubmed: 31129599
pmcid: 6538095
doi: 10.1136/bmjopen-2018-028344
Rosbach M, Andersen JS. Patient-experienced burden of treatment in patients with multimorbidity - A systematic review of qualitative data. PLoS ONE. 2017;12(6):e0179916.
pubmed: 28644877
pmcid: 5482482
doi: 10.1371/journal.pone.0179916
Bunn F, Goodman C, Russell B, Wilson P, Manthorpe J, Rait G, et al. Supporting shared decision making for older people with multiple health and social care needs: a realist synthesis. BMC Geriatr. 2018;18(1):165.
pubmed: 30021527
pmcid: 6052575
doi: 10.1186/s12877-018-0853-9
Novak M, Costantini L, Schneider S, Beanlands H, editors. Approaches to self‐management in chronic illness. Seminars in dialysis; 2013: Wiley Online Library.
Thorne S, Paterson B, Russell C. The structure of everyday self-care decision making in chronic illness. Qual Health Res. 2003;13(10):1337–52.
pubmed: 14658350
doi: 10.1177/1049732303258039
Paterson B, Thorne S, Russell C. Disease-specific influences on meaning and significance in self-care decision-making in chronic illness. Canadian Journal of Nursing Research Archive. 2002.
Yin K, Jung J, Coiera E, Laranjo L, Blandford A, Khoja A, et al. Patient Work and Their Contexts: Scoping Review. J Med Internet Res. 2020;22(6):e16656.
pubmed: 32484449
pmcid: 7298639
doi: 10.2196/16656
Heidenreich Paul A, Bozkurt B, Aguilar D, Allen Larry A, Byun Joni J, Colvin Monica M, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. J Am Coll Cardiol. 2022;79(17):e263–421.
pubmed: 35379503
doi: 10.1016/j.jacc.2021.12.012
Educators AAoD. An effective model of diabetes care and education: revising the AADE7 Self-Care Behaviors®. The Diabetes Educator. 2020;46(2):139–60.
Lee KS, Oh S. An Integrative Review of the Symptom Perception Process in Heart Failure. J Cardiovasc Nurs. 2022;37(2):122–33.
pubmed: 32925235
doi: 10.1097/JCN.0000000000000750
Lee KS, Moser DK, Dracup K. The association between comorbidities and self-care of heart failure: a cross-sectional study. BMC Cardiovasc Disord. 2023;23(1):157.
pubmed: 36973664
pmcid: 10045230
doi: 10.1186/s12872-023-03166-2
Ridgeway JL, Egginton JS, Tiedje K, Linzer M, Boehm D, Poplau S, et al. Factors that lessen the burden of treatment in complex patients with chronic conditions: a qualitative study. Patient preference and adherence. 2014:339–51.
Adelman RD, Tmanova LL, Delgado D, Dion S, Lachs MS. Caregiver burden: a clinical review. JAMA. 2014;311(10):1052–60.
pubmed: 24618967
doi: 10.1001/jama.2014.304
Suksatan W, Tankumpuan T, Davidson PM. Heart failure caregiver burden and outcomes: a systematic review. J Prim Care Community Health. 2022;13:21501319221112584.
pubmed: 35938489
pmcid: 9364181
doi: 10.1177/21501319221112584
Tran VT, Montori VM, Eton DT, Baruch D, Falissard B, Ravaud P. Development and description of measurement properties of an instrument to assess treatment burden among patients with multiple chronic conditions. BMC Med. 2012;10:68.
pubmed: 22762722
pmcid: 3402984
doi: 10.1186/1741-7015-10-68