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Time toxicity in chronic disease comorbidity care: A concept analysis using Walker and Avant’s approach

Year: 2026

Type: article

Abstract: Objectives: This study aimed to conceptually analyze time toxicity within the context of chronic disease comorbidity, identifying its defining attributes, antecedents, and consequences to guide future nursing practice and patient-centered care strategies. Methods: This study adopted Walker and Avant's eight-step concept analysis approach, integrating thematic analysis with framework analysis. A systematic search was conducted, then, peer-reviewed literature and clinical guidelines were included and the defining attributes, antecedents, consequences, and empirical referents of time toxicity were extracted. Qualitative data were analyzed using NVivo 12, employing iterative coding and categorization. The summary themes were structured into a three-tiered conceptual framework. The conceptual boundaries were rigorously refined through the examination of exemplar, borderline, and contrary cases. Results: A total of 35 articles were included. This study identified seven key defining attributes of time toxicity in chronic disease comorbidities: psychological burden, burden of chronic disease management, caregiver burden, medication burden, time burden, economic burden, and healthcare inequities. The antecedents of time toxicity include changes in patient conditions, deficiencies in support systems, and inefficiencies within the healthcare system, all of which interact to exacerbate its effects. The consequences for patients include declines in quality of life, impaired self-management, and deteriorating mental health, alongside increased healthcare utilization costs. Chronic disease comorbidity time toxicity can be defined as the increasingly severe, multifaceted burdens faced by patients managing multiple chronic diseases. Conclusions: Time toxicity is a multidimensional construct significantly affecting patients with chronic disease comorbidity. Recognizing and addressing it is vital for improving health outcomes. Nurses and care coordinators are uniquely positioned to implement time-conscious, personalized interventions.

Source: International Journal of Nursing Sciences

DOI: 10.1016/j.ijnss.2026.02.004

Authors: Ping Song, Su’e Yuan, Yuzhu Guan, Yujia Chen, Haijing Ma, Yunxia Li