Congestive heart failure self-management among US veterans: The role of personal and professional advocates

Skaperdas, Eleni; Tuepker, Anaïs; Nicolaidis, Christina; Robb, Jessica K.; Kansagara, Devan; Hickam, David H.

doi:10.1016/j.pec.2014.03.002

Cited by 12 publications

(26 citation statements)

References 25 publications

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“…The HF literature has recognized the importance of spouses and partners as ‘informal caregivers’ in HF care, particularly in relation to patients’ ability to effectively enact self‐care recommendations . Our results add to this the suggestion that the emerging conceptualization of ‘informal caregivers’ might be usefully broadened to include neighbours, community members such as ministers, and informal supporters such as drivers . While not all patients may identify such a broad range of individuals, for those who do, recognition of their roles may assist health professionals to understand and collaborate with patients’ entire supportive care networks.…”

Section: Discussionmentioning

confidence: 64%

‘Who is on your health‐care team?’ Asking individuals with heart failure about care team membership and roles

LaDonna

Bates

McDougall

et al. 2016

Health Expectations

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BackgroundComplex, chronically ill patients require interprofessional teams to address their multiple health needs; heart failure (HF) is an iconic example of this growing problem. While patients are the common denominator in interprofessional care teams, patients have not explicitly informed our understanding of team composition and function. Their perspectives are crucial for improving quality, patient‐centred care.ObjectivesTo explore how individuals with HF conceptualize their care team, and perceive team members' roles.Setting and ParticipantsIndividuals with advanced HF were recruited from five cities in three Canadian provinces.DesignIndividuals were asked to identify their HF care team during semi‐structured interviews. Team members' titles and roles, quotes pertaining to team composition and function, and frailty criteria were extracted and analysed using descriptive statistics and content analysis.ResultsA total of 62 individuals with HF identified 2–19 team members. Caregivers, nurses, family physicians and cardiologists were frequently identified; teams also included dentists, foot care specialists, drivers, housekeepers and spiritual advisors. Most individuals met frailty criteria and described participating in self‐management.DiscussionIndividuals with HF perceived being active participants, not passive recipients, of care. They identified teams that were larger and more diverse than traditional biomedical conceptualizations. However, the nature and importance of team members' roles varied according to needs, relationships and context. Patients' degree of agency was negotiated within this context, causing multiple, sometimes conflicting, responses.ConclusionIgnoring the patient's role on the care team may contribute to fragmented care. However, understanding the team through the patient's lens – and collaborating meaningfully among identified team members – may improve health‐care delivery.

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Section: Discussionmentioning

confidence: 64%

‘Who is on your health‐care team?’ Asking individuals with heart failure about care team membership and roles

LaDonna

Bates

McDougall

et al. 2016

Health Expectations

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“…Inadequate knowledge of HF diagnosis and symptoms meant that patients often looked elsewhere for more comprehensible explanations for their symptoms. A number of patients attributed symptoms to ageing, comorbid conditions, such as atrial fibrillation (AF), stress, medication side effects, cold and flu, environmental causes (hot weather), drinking, or smoking [55,62,67,49,66,59,68,56,51].…”

Section: Evaluating Symptomsmentioning

confidence: 99%

Care-seeking decisions for worsening symptoms in heart failure: a qualitative metasynthesis

2015

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Over 50 % of heart failure (HF) patients delay seeking help for worsening symptoms until these reach acute levels and require emergency hospitalisation. This metasynthesis aimed to identify and explore factors influencing timely care-seeking in patients with HF. Electronic databases searched were MEDLINE, Embase, and CINAHL. Studies were included if they were peer-reviewed journal articles, written in English, and reported perspectives of HF patients following qualitative data collection and analysis. Forty articles underwent analysis following the approach of Thomas and Harden. Leventhal's self-regulatory model (SRM) was used to organise the literature. Much of the literature fits within the SRM; however, this model did not account for all factors that influence patients' care-seeking for worsening symptoms. Factors not accounted for included patients' appraisals of previous care-seeking experiences, perceived system and provider barriers to accessing care, and the influence of external appraisals. When added to factors already represented in the model, such as misattribution of symptoms, not identifying with HF diagnosis, cognitive status, lack of understanding information provided, adaptation to symptoms, and emotional responses, a more comprehensive account of patients' decision-making was revealed. This metasynthesis identified factors, as yet unaccounted for, in a prominent model, and has suggested a more comprehensive framework for addressing care-seeking in HF patients. This information can be used to tailor education, communication, and service initiatives to improve HF patients' responses to worsening symptoms and target those most at risk of delay.

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“…Inability to spend quality time with family [51,70], and being forced to give up hobbies that once brought great pleasure and meaning, caused feelings of surrender, sadness, grief and longing [60,51,69,61,68,70,63].…”

Section: Depression and Low/changing Self-conceptmentioning

confidence: 99%

Care-seeking decisions for worsening symptoms in Heart Failure: a qualitative metasynthesis

Ivynian

DiGiacomo

Jha

et al. 2015

Heart, Lung and Circulation

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Purpose: Over 50% of heart failure (HF) patients delay seeking help for worsening symptoms until these reach acute levels and require emergency hospitalisation. This metasynthesis aimed to identify and explore factors influencing timely care-seeking in patients with HF.Methods: Electronic databases searched were Medline, EMBASE and CINAHL. Studies were included if they were peer reviewed journal articles written in English, and reported perspectives of HF patients following qualitative data collection and analysis. Forty articles underwent analysis following the approach of Thomas and Harden. Leventhal's self-regulatory model (SRM) was used to organise the literature.Results: Much of the literature fit within the SRM, however this model did not account for all factors that influence patients' care-seeking for worsening symptoms. Factors not accounted for included patients' appraisals of previous care-seeking experiences, perceived system and provider barriers to accessing care, and the influence of external appraisals. When added to factors already represented in the model, such as misattribution of symptoms, not identifying with HF diagnosis, cognitive status, lack of understanding information provided, adaptation to symptoms, and emotional responses, a more comprehensive account of patients' decision-making was revealed.Implications: This metasynthesis identified factors, as yet unaccounted for, in a prominent model, and has suggested a more comprehensive framework for addressing care-seeking in HF patients. This information can be used to tailor education, communication, and service initiatives to improve HF patients' responses to worsening symptoms, and target those most at risk of delay.

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Congestive heart failure self-management among US veterans: The role of personal and professional advocates

Abstract: Efforts to optimize CHF self-management should attend to health system and psychosocial barriers to care.

Cited by 12 publications

References 25 publications

‘Who is on your health‐care team?’ Asking individuals with heart failure about care team membership and roles

‘Who is on your health‐care team?’ Asking individuals with heart failure about care team membership and roles

Care-seeking decisions for worsening symptoms in heart failure: a qualitative metasynthesis

Care-seeking decisions for worsening symptoms in Heart Failure: a qualitative metasynthesis

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