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Keeping in balance on the multimorbidity tightrope: A narrative analysis of older patients’ experiences of living with and managing multimorbidity

Primary care management of patients with multimorbidity in the UK is underpinned by clinical guidelines, quality standards and measurable targets which govern practices of risk management and disease control. There is concern that standardised approaches may not always be appropriate for older patie...

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Autores principales: Fudge, Nina, Swinglehurst, Deborah
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Pergamon 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8783047/
https://www.ncbi.nlm.nih.gov/pubmed/34810031
http://dx.doi.org/10.1016/j.socscimed.2021.114532
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author Fudge, Nina
Swinglehurst, Deborah
author_facet Fudge, Nina
Swinglehurst, Deborah
author_sort Fudge, Nina
collection PubMed
description Primary care management of patients with multimorbidity in the UK is underpinned by clinical guidelines, quality standards and measurable targets which govern practices of risk management and disease control. There is concern that standardised approaches may not always be appropriate for older patients living with multimorbidity. Using a narrative approach, we elicited the voices of older people living with multiple conditions in order to rethink chronicity, and consider what their accounts might mean for reconfiguring care practices. Within an ethnographic study of multimorbidity and polypharmacy, we conducted in-depth interviews, based on the Biographical Narrative Interpretive Method, with 24 participants aged 65 to 94. Participants were recruited from three general practices in England. All had two or more chronic conditions and were prescribed ten or more medicines. Our analysis draws on Bakhtinian theory, tracing the multiple ways in which participants voiced living with multimorbidity. In this paper, we focus on ‘keeping in balance’ which emerged as a key meta-conceptualisation across our dataset. Adopting the metaphor of the ‘multimorbidity tightrope’ we explore the precarity of patients' experiences and show their struggle to create coherence from within a deeply ambiguous living situation. We consider how and to what extent participants' narrative constructions co-opt or resist normative biomedical framings of multimorbidity. Our analysis foregrounds the complex ways in which patients' voices and values may sometimes be at odds with those promoted within professional guidelines. Narrative approaches may offer significant potential for reorienting healthcare towards enabling patients to live a flourishing life, even when facing significant adversity.
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spelling pubmed-87830472022-01-28 Keeping in balance on the multimorbidity tightrope: A narrative analysis of older patients’ experiences of living with and managing multimorbidity Fudge, Nina Swinglehurst, Deborah Soc Sci Med Article Primary care management of patients with multimorbidity in the UK is underpinned by clinical guidelines, quality standards and measurable targets which govern practices of risk management and disease control. There is concern that standardised approaches may not always be appropriate for older patients living with multimorbidity. Using a narrative approach, we elicited the voices of older people living with multiple conditions in order to rethink chronicity, and consider what their accounts might mean for reconfiguring care practices. Within an ethnographic study of multimorbidity and polypharmacy, we conducted in-depth interviews, based on the Biographical Narrative Interpretive Method, with 24 participants aged 65 to 94. Participants were recruited from three general practices in England. All had two or more chronic conditions and were prescribed ten or more medicines. Our analysis draws on Bakhtinian theory, tracing the multiple ways in which participants voiced living with multimorbidity. In this paper, we focus on ‘keeping in balance’ which emerged as a key meta-conceptualisation across our dataset. Adopting the metaphor of the ‘multimorbidity tightrope’ we explore the precarity of patients' experiences and show their struggle to create coherence from within a deeply ambiguous living situation. We consider how and to what extent participants' narrative constructions co-opt or resist normative biomedical framings of multimorbidity. Our analysis foregrounds the complex ways in which patients' voices and values may sometimes be at odds with those promoted within professional guidelines. Narrative approaches may offer significant potential for reorienting healthcare towards enabling patients to live a flourishing life, even when facing significant adversity. Pergamon 2022-01 /pmc/articles/PMC8783047/ /pubmed/34810031 http://dx.doi.org/10.1016/j.socscimed.2021.114532 Text en © 2021 The Authors https://creativecommons.org/licenses/by/4.0/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Fudge, Nina
Swinglehurst, Deborah
Keeping in balance on the multimorbidity tightrope: A narrative analysis of older patients’ experiences of living with and managing multimorbidity
title Keeping in balance on the multimorbidity tightrope: A narrative analysis of older patients’ experiences of living with and managing multimorbidity
title_full Keeping in balance on the multimorbidity tightrope: A narrative analysis of older patients’ experiences of living with and managing multimorbidity
title_fullStr Keeping in balance on the multimorbidity tightrope: A narrative analysis of older patients’ experiences of living with and managing multimorbidity
title_full_unstemmed Keeping in balance on the multimorbidity tightrope: A narrative analysis of older patients’ experiences of living with and managing multimorbidity
title_short Keeping in balance on the multimorbidity tightrope: A narrative analysis of older patients’ experiences of living with and managing multimorbidity
title_sort keeping in balance on the multimorbidity tightrope: a narrative analysis of older patients’ experiences of living with and managing multimorbidity
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8783047/
https://www.ncbi.nlm.nih.gov/pubmed/34810031
http://dx.doi.org/10.1016/j.socscimed.2021.114532
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