The gap between policy and practice: a systematic review of patient-centred care interventions in chronic heart failure

Abstract

Patient-centred care (PCC) is recommended in policy documents for chronic heart failure (CHF) service provision, yet it lacks an agreed definition. A systematic review was conducted to identify PCC interventions in CHF and to describe the PCC domains and outcomes. Medline, Embase, CINAHL, PsycINFO, ASSIA, the Cochrane database, clinicaltrials.gov, key journals and citations were searched for original studies on patients with CHF staged II–IV using the New York Heart Association (NYHA) classification. Included interventions actively supported patients to play informed, active roles in decision-making about their goals of care. Search terms included ‘patient-centred care’, ‘quality of life’ and ‘shared decision making’. Of 13,944 screened citations, 15 articles regarding 10 studies were included involving 2540 CHF patients. Three studies were randomised controlled trials, and seven were non-randomised studies. PCC interventions focused on collaborative goal setting between patients and healthcare professionals regarding immediate clinical choices and future care. Core domains included healthcare professional-patient collaboration, identification of patient preferences, patient-identified goals and patient motivation. While the strength of evidence is poor, PCC has been shown to reduce symptom burden, improve health-related quality of life, reduce readmission rates and enhance patient engagement for patients with CHF. There is a small but growing body of evidence, which demonstrates the benefits of a PCC approach to care for CHF patients. Research is needed to identify the key components of effective PCC interventions before being able to deliver on policy recommendations.Electronic supplementary materialThe online version of this article (doi:10.1007/s10741-015-9508-5) contains supplementary material, which is available to authorized users.

Feasibility and acceptability of a patient-reported outcome intervention in chronic heart failure

“…The IPOS parent patient-reported outcome measure (PROM), the Palliative Care Outcome Scale has been used in CHF 20. This intervention was developed using the Medical Research Council guidance and informed through a systematic review6 using the best available evidence4 and appropriate theory 8

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Content

The intervention involved two components; Part one was HFN education on patient-centred care and IPOS training; Part two was the subsequent use of the IPOS with recruited patients in the clinic.

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“…The intervention aimed to reduce symptom burden and improve quality of life6; this informed follow-up measure selection. The feasibility and acceptability of the selected study measures were assessed to determine those most appropriate for a definitive trial.…”

“…The Innovative Care for Chronic Conditions (ICCC) framework recommends, for chronic conditions including CHF, that patients become active, prepared and informed rather than passive healthcare recipients 2. Policy makers advise a patient-centred approach for CHF involving a holistic patients’ needs assessment and care goal preference identification3–5; aspects of care sharing a similar philosophy with palliative care 6. Patient-centred care can act to facilitate the integration of a palliative care approach into CHF management for patients with deteriorating health and high mortality risk 6…”

“…Patient-centred CHF interventions reduce symptom burden and increase patient engagement, by enabling patients to identify their needs, communicate these needs and collaborate with healthcare professionals to address these needs according to patients’ preferences 6. This process is difficult to evaluate 7.…”

“Talk to them”: Teaching communication skills to students of Traditional Chinese Medicine

“…Further, patients with chronic illness may not be seeking a cure from TCM, but rather are seeking psychological support and they perceive this to be more readily found in complementary medicine. [9,11,37] There is evidence that training health care professions in the requisite communication skills is necessary to enable them to provide patient-centred care [38][39][40] and there is an abundance of literature on the positive effects of communication on the outcomes of health care. There is little data available, however, on how this could be addressed and sustained in health professionals education programs, and how receptive students are to it.…”