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Multi-Morbidities SBM Special Interest Group Update
Jerry M. Suls, PhD, Multi-Morbidities SIG Chair
There has been a tendency in behavioral medicine to focus on one physical condition at a time. This is not surprising: randomized clinical trials testing a treatment for a particular condition usually excludes patients who also have other conditions. Studying one disease at a time limits confounding and is usually more manageable for researchers. However, multi-morbidities (i.e., 2 or more physical diseases) are prevalent, often have common risk factors, and may be the targets of similar behavioral interventions. Furthermore, there is mounting evidence that treatments for certain diseases can increase the risk for others. For example, cancer treatments, such as radiation therapy and chemotherapy, can increase cardiac dysfunction. Lastly, one has to pose the question of how generalizable are results with patients who suffer from only a single condition. (A companion question is how difficult is it to find such individuals?) The "Multi-Morbidities Special Interest Group" was organized to be a forum to discuss and promote advances in prevention, treatment, common biological mechanisms and health policy with respect to multi-morbidities. (Some researchers and practitioners prefer the phrase, "Multiple Chronic Conditions" or MCC, to multi-morbidities.) Please consider joining the "MM Sig."
At its first SIG Meeting, during the 2013 Annual Meeting of SBM, there was a lively and enlightening discussion. One attendee observed that it was important for Multi-Morbidities to be promoted as a topic in the journals, at professional conferences and before important governmental agencies (including NIH) to make sure the focus was not only on "disease silo's." Another attendee emphasized that clinical guidelines that do not take into account co-occurring disease conditions fail to fully address needs of a large proportion of patients, especially older adults. Other discussion focused on the need for certain kinds of epidemiological and health care information. Although there are data on the associations between demographic variables and co-occurring physical conditions documentation of the temporal trajectories of multiple conditions (e.g., is one disorder manifested prior to another in a regular sequence?) is scarce. Another concern was that too little is known about the cumulative effects of co-occurring illnesses on quality of life. One voice noted that certain patterns of multi-morbidities are understudied, but in the field of cardiac diseases, there is attention paid to the co-occurrence of hypertension, diabetes, and kidney failure. Hence, cardiovascular behavior medicine may have lessons for other sub-disciplines. Finally, attendees noted that "frailty" and inflammation have broad applicability and may offer important insights for understanding, preventing and treating multi-morbidities. To continue the discussion, the SIG has a listserv; also look for a future announcement for the morning session of the Multi-Morbidities SIG at the 2014 SBM annual meeting.
In "multi-morbidity" news:
Multiple chronic conditions have become a major topic of interest for the U.S. Department of Health and Human Services and other organizations (see www.hhs.gov/ash/initiatives/mcc/index.html)?. For example, HHS outlines a strategic framework, a data base of MCC-relevant programs, tools and research initiatives. This website is a useful resource for behavioral medicine researchers and interventionists who want to familiarize themselves with the topic. The National Council on Aging, among other nonprofit and service advocacy organizations, has set as one of its strategic goals for 2020 to "Improve the health of 4 million older adults with multiple serious health problems through participation in cost-effective evidence-based programs." In the near future, one can expect a variety of governmental and other stakeholder initiatives for research support and evidence-based treatments for MCC's.
SBM has plans to have a Multi-Morbidities Workshop at the 35th Annual Meeting. Talks by experts will focus on how to best assess multi-morbidities, the role of self-management, mechanisms, and policy implications, especially in the context of the Affordable Care Act.
A useful resource is a special issue devoted to multi-morbidities published in the journal Preventing Chronic Disease: Public Health Research, Practice, and Policy in April 2013. Another resource is a detailed graphic that resulted from a special NCI-sponsored Workshop held in Utah in 2011. Although the focus of the meeting was on the intersection of cardiac and cancer diseases, featuring many leaders in psycho-oncology and cardiovascular behavioral medicine, the graph presentation has relevance to all multi-morbidities. (See http://cancercontrol.cancer.gov/brp/bbpsb/complex.html).
The Multi-Morbidities SIG has a listserv: MM_SIG@list.sbm.org