Multimorbidity PhD programme for Health Professionals

Multimorbidity and generalized frailty – even amongst younger populations -- are increasingly important problems for health services. In narrowly specialized services designed to manage single disease these problems created two kinds of difficulty for patients and caregivers:

(i) they experience significant burdens of symptoms and burdens of treatment that combine to reduce their capacity to participate effectively in their own care (1,2). Our work has developed robust explanatory models of the ways in which symptom burden (patient and caregiver capacity) and treatment burden (patient and caregiver workload) interact (3,4). Existing models and measures of treatment burden assume an arithmetical relationship between workload and capacity in complex long-term conditions, but we do not know whether this is true.

Furthermore, we do not know what aspects of patient and caregiver capacity matter in everyday life. This gap in knowledge is important, because the organization and delivery of care for people with complex long-term conditions, multimorbidity and frailty depends on them being able to contribute effectively and fully to their own care. What matters here is likely to be complex and situational interactions between different components of these health problems, supportive (or unsupportive) social networks, and health services. These interactions are likely to be complicated by structural, intersectional and spatial inequalities that we already know have profound effects on lived experience of health and health care.