Improving Self-Care for Heart Failure for Seniors: The Impact of Video and Written Education and Decision Aids

Abstract

Heart failure poses a substantial burden on health care expenditures and quality of life; therefore, strategies to improve health behaviors for heart failure are essential. Highly effective medical decision aids can enable health improvements for people with heart failure. In this randomized controlled study, individuals with heart failure in a private Medicare plan were randomized into either an intervention or control group. Participants in the intervention group received basic program information and a simple fact sheet about heart failure, plus a medical decision aid, Living with Heart Failure DVD and booklet; patients randomized to the control group received the basic written materials only. The study was powered to detect a 5% difference in the primary outcome measure (daily weight monitoring). Participants were surveyed 4 weeks after outreach materials were mailed. There were 480 survey respondents: 246 in the intervention group; 234 in the control group. Intervention group respondents were significantly more likely to weigh themselves daily (P=0.05) than control group respondents (44% versus 38%). The intervention group was more likely than the control group to monitor fluid intake (47% versus 44%) and follow a low-sodium diet (83% versus 77%). Other health behavior differences were not statistically significant. The DVD decision aid increased levels of daily weight monitoring and other important health behaviors. Broad application of inexpensive behavior change interventions, such as a DVD/booklet program, should help to facilitate important, routine self-care behaviors for individuals with heart failure.

Shared Decision Making

“…Randomized, controlled trials of DAs for coronary artery disease treatment, statin use, anticoagulation for atrial fibrillation, heart failure self-management, vascular access for cardiac catheterization, acute low-risk chest pain, and coronary artery disease prevention have shown that use of such DAs improves the decision-making process by increasing knowledge, improving risk communication, decreasing decisional conflict, increasing participation in care, and increasing value congruence. [43][44][45][46][47][48] The effect of DAs on such outcomes as self-efficacy and medication adherence has not yet been definitively established.…”

“…Veroff et al 46 found that heart failure patients randomized to receive a DA were significantly more likely to weigh themselves daily, monitor fluid intake, and limit salt intake than those not receiving a DA. However, there was only short-term follow-up (4 weeks).…”

Multimedia psychoeducational interventions to support patient self-care in degenerative conditions: A realist review

“…Three papers were focused on people with heart failure (Albert, Buchsbaum, & Li, 2007;Boyde et al, 2013;Veroff et al, 2012); two on those with cancer pain (Capewell, Gregory, Closs, & Bennett, 2010;Syrjala et al, 2008); and one each on people with sexual dysfunction following radical prostatectomy (Chambers et al, 2008); end-stage renal disease (Chiou & Chung, 2012); peripheral vascular disease (Collins, Krueger, Kroll, & Sharf, 2009); haemophilia related joint pain (Elander, Robinson, & Morris, 2011); and spinal cord injury (Hoffman et al, 2011).…”

“…Only one of the interventions consisted entirely of audio-visual material and this was the only intervention delivered online (Hoffman et al, 2011). The remainder consisted of audio-visual content supplemented by written material (Capewell et al, 2010;Elander et al, 2011;Veroff et al, 2012), some also with professional led face-to-face education or support (Albert et al, 2007;Boyde et al, 2013;Collins et al, 2009;Syrjala et al, 2008), or telephone contact (Chambers et al, 2008;C -P Chiou & Chung, 2012).…”

Decision Aids and Shared Decision-Making in Neurocritical Care: An Unmet Need in Our NeuroICUs

“…Visual aids, including the use of cartoons, symbols, photos, or videos may play a large role in ensuring proper understanding of medical terms. For example, video DAs have been shown to effectively help patients and proxies 22 in making more informed decisions about end-of-life care and cardiopulmonary resuscitation in patients with dementia 23 , advanced heart failure 24 , cancer 25,26 , and critically ill patients with pulmonary disease 27 . Difficult treatment decisions are derived in concert with patient’s values and preferences, which include their religious, cultural and ethnic beliefs and prior experiences.…”