Abstract
Purpose: The study reported herein sought to better understand how patients with multimorbid, chronic illness-who receive care in institutions designed for treatment of acute illness-experience and engage in health-related decisions. Methods: In an urban Canadian teaching hospital, we studied the interactions of six hemodialysis patients and 11 of the health professionals involved in their care. For 1 year (September 2009 to September 2010), we conducted ethnographic observation and interviews of six cases each comprising one hemodialysis patient and various health professionals including medical specialists, nurses, a social worker, and a dietician. Results:We found that the ubiquity and complexity of health-related decision-making in the lives of these patients suggests the need for a more holistic interpretation of health-related decision-making. Discussion:We propose an interpretation of decision-making as an ongoing process of integrating illness and life; as frequently open-ended, cumulative, and relational; and as fundamentally shaped by the fragmented delivery of care for patients with multiple morbidities. Conclusion: Our understanding of decision-making suggests that people living with complex chronic illness need to receive care from institutions that recognize and address their multi-morbidity as a whole illness that is constantly being integrated into the life of a whole person.
Original language | English |
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Pages (from-to) | 44-55 |
Number of pages | 12 |
Journal | Chronic Illness |
Volume | 11 |
Issue number | 1 |
DOIs | |
Publication status | Published - 27 Mar 2015 |
Keywords / Materials (for Non-textual outputs)
- co-morbidity
- decision-making
- fragmented care
- whole-person care