How Patient Work Changes Over Time for People with Multimorbid Type 2 Diabetes: A Qualitative Study and Implications for Digital Support (Preprint)

K Yin, J Jung, E Coiera, KWK Ho, S Vagholkar, Ann Blandford, F Rapport, AYS Lau
in Working/Discussion Paper

Abstract

BACKGROUND
The experiences of patients change throughout their illness trajectory and differs according to their medical history, however digital support tools are often designed for one specific moment in time and unable to change with the patient as their health states change. This presents a fragmented support pattern where patients have to move from one app to another as they move between health states, and some sub-populations of patients do not have their needs addressed at all.

                OBJECTIVE
                    To investigate how patient work evolves over time for those living with Type 2 diabetes mellitus and chronic multimorbidity, and explore implications for digital support system design.

                METHODS
                    26 people with Type 2 diabetes mellitus and chronic multimorbidity were recruited. Each was interviewed twice, and interviews were transcribed and analyzed according to the Chronic Illness Trajectory Model.

                RESULTS
                    Four unique illness trajectories were identified with different patient work patterns and needs: 1/ Living with stable chronic conditions involves patients seeking to make patient work as routinized and invisible as possible; 2/ Dealing with cycles of acute or crisis episodes included heavily multimorbid patients who sought support with therapy adherence; 3/ Responding to unstable changes described patients currently experiencing rapid health changes and increasing patient work intensity, and 4/ Coming back from crisis focused on patients coping with a loss of normalcy.

                CONCLUSIONS
                    Patient work changes over time based on the experiences of the individual, with its timing and trajectory needing to be considered when designing digital support interventions.

                INTERNATIONAL REGISTERED REPORT
                    RR2-http://dx.doi.org/10.1136/bmjopen-2018-022163