Feasibility and preliminary effects of a coping-focused dyadic family resilience intervention for breast cancer patients and their family caregivers: a pilot study.

The coexistence of 2 or more long-term (chronic) conditions, commonly referred to as multiple long-term conditions (MLTCs) or multimorbidity, is a major global public-health problem with rates expected to rise over the next 30 years as populations live longer []. MLTCs affect populations across low, middle, and high-income countries [], with global estimates suggesting that around 37.2% of adults living in the community are affected []. The prevalence of MLTCs increases with age, although the greatest number of people affected are those under 65 years old []. People with MLTCs are more likely to experience difficulties accessing and navigating health care services [], functional limitations, poorer quality of life, reduced ability to work, and lower life expectancy []. MLTCs increase demand on health systems, particularly within primary care, where most receive their care []. People living with MLTCs also encounter unique challenges such as fragmented care with limited continuity between multiple health care providers, as well as poor coordination across services []. Subanalysis of patient experience surveys in primary care suggests that satisfaction with care declines as the number of conditions increases, and perceptions of care quality may differ from those without MLTCs []. To identify areas where the quality of care can be improved, collecting and interpreting health care performance data are crucial. Quality indicators, often referred to as quality measures or metrics, are one way to achieve this, by supporting the monitoring of the components of care associated with quality []. Rich evidence is available on the treatment burden for people with MLTCs [,], interventions to improve care [,], or individual components of care for chronic conditions [,]. However, limited consensus persists on which quality indicators best capture the quality of primary care delivered to people living with MLTCs []. Internationally published indicator sets for care quality in primary care often lack operational detail on definitions, numerators, denominators, and data sources, limiting direct transferability to current clinical care settings []. In the United Kingdom, while the National Institute for Health and Care Excellence (NICE) has produced a set of quality indicators intended to capture the processes of care relevant to those living with MLTCs, these have not been implemented through the national pay-for-performance program implemented in general practices (GPs) []. Through this program, payments to GPs are made according to the achievement of disease-specific quality indicator targets []. As a result, quality of care for people living with MLTCs continues to be monitored through aggregated analysis of these disease-specific Quality Outcomes Framework (QOF) indicators []. The limitation of these single-disease indicators is that they do not adequately reflect the complexity of living or caring for people with MLTCs, whose care and lived experience is not only shaped by their chronic conditions, but by an interplay of social, economic, and physical variables [,].