People with long-term health problems, such as lung or heart disease, often have other health problems too. This is known as “multi-morbidity”. Multi-morbidity affects a quarter of the general population and half of those aged 65+. It is more common in deprived areas. People with multi-morbidity usually have poorer quality of life and die younger. They need lots of different types of health support, especially from GP surgeries. Family and friends who support people with multi-morbidity (carers) often have difficulties with their own health and wellbeing, because of their caring role. This can lead to healthcare crises for both the patient and the carer.
Patients, carers and care professionals have told us that care for people with multi-morbidity should be driven by patients’ and carers’ needs. This is known as “person-centred care.” The NHS recommends it, but there is little guidance on how to provide it.
Members of our team developed two ways (interventions) to do this: one for patients (SNAP) and one for carers (CSNAT-I). Both use a tool (a set of questions to help the patient or carer think about areas where they need more support) and a focussed conversation between the patient or carer and care professional to help address those needs. These interventions are used widely and have been shown to be helpful, but they have not been used together before, nor investigated specifically for people living with multi-morbidity. We want to offer both interventions together, as a new patient and carer intervention called “SUPPORT”. SUPPORT could be used by patients and carers jointly, or separately, depending on their circumstances and preferences.
The SUPPORT Programme aims to improve outcomes for people living with multi-morbidity through a co-developed intervention that enables identification and response to patient and carer support needs.
To do this we will investigate SUPPORT to find out:
- How the intervention works?
- The circumstances in which it works
- Who it works for (and who it does not work for)?
- How we could roll out the programme if successful?
Before we can apply for funding to do this investigation, we have some important questions we need to answer about how we would provide the intervention and how we would investigate it – so we have first applied for an NIHR Programme Development Grant to help us answer these questions. This will then enable us to apply for funding to run a larger study to find out when and how SUPPORT works best for patients and carers living with multi-morbidity.
The SUPPORT Programme has the potential for wide-ranging impact by enabling person-centred care in multi-morbidity through an evidence-based intervention that identifies, prioritises and addresses unmet support needs of patients and carers. Other studies have shown that providing care in this way can enhance the quality of care quality, improve quality of life, increase patients’ involvement in their care and managing their conditions, reduce the burden of living with their conditions, reduce the use of services, and bring satisfaction to patients, families, informal carers and care providers.
The programme will also help raise awareness of the importance of informal carers and the need to support them – so that care is centred around the patient and their informal carer, not just the patient. It will also help improve patients’ and carers’ mutual understanding and support of one another.
What we learn could be useful for other interventions seeking to support patients and carers together.
We are awaiting the outcome of the NIHR Programme Development Grant application (September 2020).
Who is involved?
Professor Morag Farquhar, University of East Anglia
Researchers and institutions
Morag Farquhar, M.Farquhar@uea.ac.uk