Methods: In a mixed-methods longitudinal case study (n=8), we interviewed patients and providers immediately after the index encounter, followed by patient telephone-interviews over 12-weeks (8 data collection points). We analyzed interviews using open coding and theme identification. We collected quantitative scores on self-management, illness perception, symptoms, and viral load and these were analyzed with qualitative data to plot symptom trajectories in relation to SM and adaptive work.
Results: Adaptive challenges (e.g., fatigue, adherence, side effects) were overwhelming. Severity of symptoms fluctuated with patients’ adaptive capacity for SM. Providers’ adaptive leadership strategies were limited primarily to raising the patients’ awareness of expected symptom challenges of treatment. Providers focused on relaying technical information about medication and adherence. Missed opportunities for assisting patients with adaptive work to improve self-management were evident. Providers placed little emphasis on expected treatment response predicted by genotype.
Conclusion: The study provided knowledge for developing interventions for enhancing adaptive leadership behaviors of providers that facilitate adaptive capacity of patients. System changes may be needed because too much information is transferred in the index encounter.