‘Engage me in taking care of my heart’: a grounded theory study on patient–cardiologist relationship in the hospital management of heart failure

Abstract

ObjectiveIn approaching the study and practice of heart failure (HF) management, authors recognise that the patient–doctor relationship has a central role in engaging patients in their care. This study aims at identifying the features and the levers of HF patient engagement and suggestions for orienting clinical encounters.DesignUsing a grounded theory approach, we conducted 22 in-depth interviews (13 patients with HF, 5 physicians and 4 caregivers). Data were collected and analysed using open, axial and selective coding procedures according to the grounded theory principles.SettingsAll interviews were conducted in an office in a university hospital located in a metropolitan area of Milan, Italy.ParticipantsThe data comprised a total of 22 patient, hospital cardiologist and caregiver interviews. Patients aged ≥18 years with New York Heart Association (NYHA) Functional Class of II or III were eligible to take part. Patients were recruited primarily through their referral cardiologist.ResultsThe HF patient engagement process develops in four main phases that are characterised by different patients’ emotional, cognitive and behavioural dynamics that contribute to shape the process of a patient's meaning making towards health and illness regarding their care. The emerging model illustrates that HF patient engagement entails a meaning-making process enacted by the patient after the critical event. This implies patients’ ability to give sense to their care experience and to their disease, symptomatology and treatments, and their changes along their illness course. Doctors are recognised as crucial in fostering patients’ engagement along all the phases of the process as they contribute to providing patients with self-continuity and give new meaning to their illness experience.ConclusionsThis study identifies the core experiential domains and the main levers involved in driving patients with HF to effectively engage in their disease management. The model emerging from this study may help clinicians think in a fresh way about encounters with patients and their role in fostering their patients’ health engagement.

Engaging patients to recover life projectuality: an Italian cross-disease framework

“…Patients had received treatment for the qualifying illnesses during at least the 6 months prior to the interview, were fluent in Italian, and did not have any active psychiatric disorders or cognitive impairments. Potentially, eligible patients were then telephoned by a clinician from the study sites, to obtain 1 According to the patient engagement model by Graffigna et al [16,17], patient engagement is a process featuring four sequential phases. In the phase of ''blackout'', patients fall in an initial state of emotional, behavioral and cognitive blackout determined by the critical event, which is described as unexpected and out of their control.…”

“…This is a second-level study that composes a part of a multi-phase, multi-site cross-sectional research examining the engagement in health care of patients with chronic conditions [16][17][18][19]. The patients included in this study were selected to provide a sample with balanced demographic and clinical conditions (Table 1).…”

“…Thus, making patients really engaged in their care means to sustain them in reaching a status of ''eudaimonic project'' in which they are able to attribute full meaning to their healthcare experience, and enact self-management behaviors effectively, in due time, even when life contexts change. In this position, patients also develop a more mature and psychologically sustainable perspective about their diseases, which can now be better integrated into their life projects [16][17][18][19].…”

Engaged patients, engaged partnerships: singles and partners dealing with an acute cardiac event

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Patient Self-Management In Chronic Heart Failure — Establishing Concordance Between Guidelines And Practice

“…Indeed, research suggests that the link between patient confidence and selfcare 1,34 may depend on the quality of the patient-health professional relationship. 35 However, problematic patient-physician interactions continue to be among the most commonly reported barriers to patient self-management, 36 e-health strategies will likely form a pivotal role in addressing these shortfalls. Trials in progress, such as PROMETHUS37, BEAT-HF 38 and CHF-CePPORT 39 will examine whether e-health platforms can overcome patient barriers, such as cognitive impairment, to improve self-management in CHF.…”