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From Self-Management to Shared-Management: A Relational Approach for Equitable Chronic Care

Accepted version
Peer-reviewed

Type

Article

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Authors

Stutzin Donoso, Francisca  ORCID logo  https://orcid.org/0000-0003-1590-1226

Abstract

jats:pLife with chronic disease and chronic care is hard and people who live in disadvantage may lack the freedom to prioritise their care because of increased competing demands. This paper proposes that shifting the goals of chronic care from self-management support to a shared-management approach can help improve wellbeing and health outcomes across social groups. This work draws on a qualitative exploration of the lived experience of chronic disease and an applied ethical analysis of the reproduction of disadvantages within chronic care. The qualitative results further specify respectful and collaborative patient-healthcare professional relationships; autonomy-supportive interventions; and continuity of care to face the complexity of chronicity in a phenomenological sense—a paradoxical experience of long duration that comprises the disease’s presence in the absence of its manifestation. The ethical analysis draws on performativity; autonomy and decision-making; and responsibility, which constitute the theoretical foundation for shared-management. This approach contributes to advance current normative thinking for health justice and outlines practical steps for its clinical implementation in the delivery of chronic care.</jats:p>

Description

Keywords

health inequalities, chronic disease, justice

Journal Title

Public Health Ethics

Conference Name

Journal ISSN

1754-9973
1754-9981

Volume Title

Publisher

Oxford University Press (OUP)
Sponsorship
National Research and Development Agency (ANID) of the Chilean Government, programme Becas-Chile Scholarship.
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