Abstract CN01-02: Facilitating the patient-centeredness of care for individuals with multiple chronic illnesses: Why does it matter?
Authors: Arora Neeraj K. , Hesse Bradford W. , Glasgow Russell 
Published: May 2015

Abstract
Patient-centeredness is a critical component of high quality care. In order to facilitate research focused on the delivery of patient-centered care, the National Cancer Institute (NCI) published a monograph in 2007 titled “Patient-Centered Communication in Cancer Care: Promoting Healing And Reducing Suffering.” This monograph proposed a conceptual framework that identified six key functions of patient-centered communication (PCC) that healthcare organizations will need to facilitate in order to optimize patient health outcomes (fostering healing relationships, exchanging information, making decisions, addressing emotions, enabling patient self-management, and managing uncertainty). Using data from NCI's 2012 Health Information National Trends Survey, based on NCI's six function PCC framework, we evaluated the patient-centeredness of care delivered to individuals living with multiple (≥2) chronic conditions (MCC) in the U.S. and examined potential sources of disparities in the delivery of PCC for these individuals. We also examined the association between PCC and patients' self-efficacy for taking care of their health.
The 2012 Health Information National Trends Survey collected self-reported data on a diagnosis of 7 chronic illnesses (cancer, diabetes, hypertension, heart disease, arthritis, chronic lung disease, and depression/anxiety). Responses to items mapping onto NCI's six function PCC framework and patients' self-efficacy were also collected. Analyses were based on data from 3,000 respondents who had at least one medical visit in the past year.
Overall, 48% of respondents were diagnosed with MCC. Significant deficits in PCC were reported (e.g., 1-in-6 were rarely involved in decisions as much as they wanted; 1-in-5 rarely received needed attention to their emotions). PCC scores, however, did not vary by number of chronic illnesses. A third of respondents reported limited confidence (not at all/little/somewhat confident) in taking care of their health. Self-efficacy significantly decreased with the number of illnesses (P&lt;0.001). In analyses adjusted for patient characteristics, the PCC scale score was positively associated with patient self-efficacy (P&lt;0.001); the strength of this relationship increased with number of chronic illnesses (regression coefficient for PCC ranged from 0.15 for no condition to 0.25 for 3+ conditions).
The increasing burden of MCC in the U.S. is likely to result in diminished patient efficacy in taking care of their health. Efforts at improving the patient-centered aspects of care are likely to facilitate greater patient engagement in this important patient population.
Citation Format: Neeraj K. Arora, Bradford W. Hesse, Russell Glasgow. Facilitating the patient-centeredness of care for individuals with multiple chronic illnesses: Why does it matter?. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr CN01-02. doi:10.1158/1538-7755.DISP13-CN01-02