XXXX in primary care and the limits of instrumental rationality in chronic illness self-management.

@entity1 @entity740
UNASSIGNED: Early detection of long term conditions is predicated on assumptions that lifestyle changes and medications can be used to reduce or manage the risk of condition progression. However, ambiguity remains about the nature and place of diagnostic disclosure to @entity1 in newly recognised or asymptomatic 'pre' conditions such as early stage @entity740 ( @entity740 ). The disclosure of a diagnosis is relevant to instigating strategies which rely on actively engaging @entity1 as self-managers of their own care. Whilst primary care routinely records a diagnosis of early stage @entity740 , little is known about how @entity1 learn about the fact that they have @entity740 or how they respond to this. This study aimed to explore @entity1 ' experiences of disclosure of @entity740 in primary care settings. A nested qualitative study of @entity1 recruited to a trial of an intervention for @entity740 @entity1 in Greater Manchester, UK was undertaken. A purposive sample of 26 @entity1 , with a mean age of 72 years (range 59-89, median 71), were interviewed during 2012. Interview transcripts were analysed using constant comparative techniques. Narrative accounts reflected limited or partial disclosure of @entity740 ; often cast in vague terms as "nothing to worry about". How @entity1 described themselves in terms of participation and their tendencies towards 'active' or 'passive' involvement in consultations emerged as important components of narratives around disclosure. The findings illuminate the ways in which diagnosis is oriented in a context where it is possible to meet the requirements for remuneration under a pay for performance system of primary care, whilst apparently not disclosing a label or a diagnosis to @entity1 . This challenges the presumptions inherent in wider health policy objectives that are increasingly built on the notion of responsible @entity1 and the ethos of the active support of self-management for pre-conditions.
