Volume 33, Issue 1 p. 21-26

The Shifting Perspectives Model of Chronic Illness

Barbara L. Paterson

Corresponding Author

Barbara L. Paterson

Barbara L. Paterson, RN, PhD, Associate Professor, University of British Columbia School of Nursing, Vancouver, BC, Canada

Dr. Paterson, University of British Columbia School of Nursing, T201-2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5. E-Mail: [email protected]Search for more papers by this author
First published: 23 April 2004
Citations: 370

The author gratefully acknowledges funding for the project from the Canadian Nurses Foundation, and the contribution and support of the co-investigators, Dr. Sally Thorne, Dr. Sonia Acorn, Connie Canam, Dr. Carol Jillings, Gloria Joachim, and Marilyn Dewis.


Purpose: To present the Shifting Perspectives Model of Chronic Illness, which was derived from a metasynthesis of 292 qualitative research studies.

Design: The model was derived from a metasynthesis of qualitative research about the reported experiences of adults with a chronic illness. The 292 primary research studies included a variety of interpretive research methods and were conducted by researchers from numerous countries and disciplines.

Methods: Metastudy, a metasynthesis method developed by the author in collaboration with six other researchers consisted of three analytic components (meta-data-analysis, metamethod, and metatheory), followed by a synthesis component in which new knowledge about the phenomenon was generated from the findings.

Findings: Many of the assumptions that underlie previous models, such as a single, linear trajectory of living with a chronic disease, were challenged. The Shifting Perspectives Model indicated that living with chronic illness was an ongoing and continually shifting process in which an illness-in-the-foreground or wellness-in-the-foreground perspective has specific functions in the person's world.

Conclusions: The Shifting Perspectives Model helps users provide an explanation of chronically ill persons' variations in their attention to symptoms over time, sometimes in ways that seem ill-advised or even harmful to their health. The model also indicates direction to health professionals about supporting people with chronic illness.