Shifting priorities in multimorbidity: a longitudinal qualitative study of patient's prioritization of multiple conditions.

OBJECTIVE: To examine what influences self-management priorities for individuals with multiple long-term conditions and how this changes over time.
METHODS: A longitudinal qualitative study using semi-structured interviews completed with 21 participants with more than one chronic condition.
RESULTS: The study demonstrates the impact of multiple conditions on many aspects of people's illness management. Narratives illuminated how individual's condition priorities changed at pivotal points and altered their engagement with self-management practices. This is influenced by contact with health professionals and how people framed illness and lifestyle changes. Medication management was a central point where individuals took control of their conditions. Additional conditions were more readily accommodated if people established a cognitive link between existing management practices. Thus, multiple conditions were not inevitably experienced as an increasing burden but subject to considerable flux and change. DISCUSSION: Prioritizing one condition over another at a particular time together with a transfer and amalgamation of practices appears to facilitate accommodation of multiple conditions and ease the burden of everyday management. These findings have implications for how we understand the variable nature of multimorbidity experience and management for patients. Clinicians might usefully engage with patients' understanding to reduce complexity, and enhance engagement of condition management.