Management reasoning (Cook et al., 2019) [35]

Multimorbidity

In management reasoning, the answer often depends.

· The reasoning aim is not to achieve a diagnosis but often to maintain stability to promote the patient’s quality of life.

· There is no “single best” choice of care plans or treatments in such complex situations with multiple diseases and several potential actions and treatments. This implies cognitive processes such as prioritization, problem articulation and anticipation.

Management reasoning is influenced by patient’s preferences and values, logistical constraints, etc., and requires the involvement of patients and healthcare professionals.

· Prioritization, problem articulation and anticipation need to be made within the context of patients’ preferences and values.

· This highlights the importance of sharing one’s own reasoning in a collaborative and constructive way with the patient (as an actor of change) and the healthcare professionals involved.

Management reasoning requires ongoing monitoring and frequent adjustments, and involves a dynamic interplay among people, systems, settings, and competing priorities.

· Care plans are not stabilized, but subject to continuous adaptation depending on changes in the prioritization of problems, goals achievement, or as a result of co-occurring events or altering contexts.

· It is therefore crucial to keep in mind a dynamic and never-ending representation of the clinical situation; this requires the clinician to permanently question his/her reasoning in order to adapt it to the patient and his/her context.