![]() ![]() The epidemic of MCCs and this new definition require a dramatic shift in the culture of providing care: when health care cannot cure, it must instead understand and develop the capacity of patients to adapt and self-manage to the chronic conditions that almost inevitably will enter their lives. Instead, a new definition has been proposed: the ability to adapt and to self-manage. In an era in which adults are more likely to live with chronic conditions than not, health can no longer be defined as the absence of disease. ![]() In part due to the successes of public health and health care and to the ageing of the population, the incidence of multiple chronic conditions (MCC) is increasing: 3 in 4 Americans 65 and older live with MCC, and the prevalence is increasing also in younger people. Next steps involve the evaluation of the impact of the ICAN Discussion Aid on clinical encounters with a variety of health professionals and the impact of ICAN-informed treatment plans on patient-important outcomes. We successfully created a discussion aid to elucidate and share insights about the capacity patients have to enact the treatment plan and hypotheses as to why this plan may or may not be enacted. The clinical review facilitated by ICAN generates hypotheses regarding why some treatment plans may be problematic and may not be enacted in the patient’s situation. Resultsįrom this process resulted the ICAN Discussion Aid, a tool completed by the patient and reviewed during the consultation in which patients classified domains that contribute to capacity as sources of burden or satisfaction clinical demands were also classified as sources of help or burden. Then we refined a final prototype with extensive stakeholder feedback. We then developed and tested prototypes in routine clinical practice. We observed clinical encounters, visited patient homes, and dialogued with patient support groups. Using user-centered design principles, we set out to create a discussion aid for use by patients, clinicians, and other health professionals during clinical encounters. Tools that enable this approach to care are needed. Clinical teams need to acknowledge, respect, and support the work that patients do and the capacity they mobilize to enact this work, and to adapt and self-manage. The needs of the growing population of complex patients with multiple chronic conditions calls for a different approach to care. ![]()
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