Stakeholders' views on a collaborative decision support system to promote multimorbidity self-management: barriers, facilitators and design implications

An estimated of 50 million people live with multiple chronic diseases (multimorbidity), and €700 billion is spent on chronic diseases in the EU. Multimorbidity is one of the main challenges facing healthcare systems, as these patients often have complex health and social care needs. The management of multimorbidity is complicated since both clinicians and patients struggle to integrate and balance the benefits and risks of multiple recommended treatments. Involving patients in the management of their own health has shown long-term health benefits, for example, self-management of blood pressure has been shown to improve patient outcomes. With the unique capabilities of smartphonesand wireless sensors, individuals can monitor a wide range of health and wellness data at home (e.g., blood pressure, activity), and many mobile “apps” to support self-management have emerged. However, each device operates in isolation and is disconnected from both the patient context and the treatment plan. By adopting a collaborative approach based on integrating and combining information from multiple sources, such as wireless sensors, patient’s electronic health record (EHR) and clinical guidelines, we aim to provide a tailored decision support system (DSS), supporting patients with multimorbidity to self-manage their treatments in home settings and clinicians to make informed decisions on treatments. In this study, we engaged stakeholders to identify facilitators and barriers to the adoption of such a DSS. Stroke survivors were selected since multimorbidity is very common in this cohort.