Experiences on Providing Home Care for A Relative with Heart Failure: A Qualitative Study

Caregivers' Contributions to Heart Failure Self-care: An Updated Systematic Review

BACKGROUND

A previous systematic review reporting the contributions of informal, unpaid caregivers to patient heart failure (HF) self-care requires updating to better inform research, practice, and policy.

OBJECTIVE

The aim of this study was to provide an updated review answering the questions: (1) What specific activities do informal caregivers of adults with HF take part in related to HF self-care? (2) Have the activities that informal caregivers of adults with HF take part in related to HF self-care changed over time? (3) What are the gaps in the science?

METHODS

This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, CINAHL, EMBASE, and Cochrane CENTRAL databases were searched. Eligible studies involved an informal, unpaid caregiver of an adult with HF as a study variable or participant. Caregiving activities were benchmarked using the theory of self-care in chronic illness.

RESULTS

Two thousand one hundred fifty-four research reports were identified, of which 64 met criteria. Caregivers' contributions occurred in self-care maintenance (91%), monitoring (54%), and management (46%). Activities performed directly on or to the patient were reported more frequently than activities performed for the patient. Change over time involved the 3 domains differentially. Gaps include ambiguous self-care activity descriptions, inadequate caregiving time quantification, and underrepresented self-care monitoring, supportive, and communication activities.

CONCLUSIONS

Newly identified caregiver-reported activities support updating the theory of self-care in chronic illness to include activities currently considered ancillary to HF self-care. Identified gaps highlight the need to define specific caregiving activities, determine task difficulty and burden, and identify caregiver self-care strategy and education needs. Exposing the hidden work of caregiving is essential to inform policy and practice.

Positive experiences of family caregivers of patients with chronic heart failure: protocol for a qualitative systematic review and meta-synthesis

INTRODUCTION

Previous studies have highlighted the experiences of caregivers for patients with chronic heart failure (CHF), specifically focusing on their negative experiences. There are few systematic reviews on the topic to synthesise the positive experiences of family caregivers for patients with CHF. This study will examine how experiences such as developing new skills, strengthening their relationships (between caregivers and recipients) and receiving appreciation from the care recipient assist to improve caregivers' perception of their circumstances.

METHODS AND ANALYSIS

This review will be conducted in accordance with the Joanna Briggs Institute (JBI) methodology for qualitative systematic reviews. Qualitative and mixed methods studies related to the positive experiences of family caregivers for patients with CHF, reported in English or Chinese and published from inception in the following databases will be included: PubMed, MEDLINE, Embase, Cochrane Library, Web of Science, PsycINFO, CINAHL, Wan Fang Data, China National Knowledge Infrastructure, Chongqing VIP, Chinese Biomedical Literature Database, Open Grey and Deep Blue Library databases. The standard JBI Critical Appraisal Checklist for Qualitative Research will be used by two independent reviewers to appraise the quality of the included studies, and the standardised JBI Qualitative Data Extraction Tool for Qualitative Research will be applied to extract data. The final synthesised findings will be graded according to the ConQual approach for establishing confidence in the output of qualitative research synthesis.

ETHICS AND DISSEMINATION

Ethical approval is not required as no primary data are being collected. The results will be made available through a peer-reviewed publication.

PROSPERO REGISTRATION NUMBER

CRD42021282159.

Quality of life and disease experience in patients with heart failure with reduced ejection fraction in Spain: a mixed-methods study

OBJECTIVES

To gather insights on the disease experience of patients with heart failure (HF) with reduced ejection fraction (HFrEF), and assess how patients' experiences and narratives related to the disease complement data collected through standardised patient-reported outcome measures (PROMs). Also, to explore new ways of evaluating the burden experienced by patients and caregivers.

DESIGN

Observational, descriptive, multicentre, cross-sectional, mixed-methods study.

SETTING

Secondary care, patient's homes.

PARTICIPANTS

Twenty patients with HFrEF (New York Heart Association (NYHA) classification I-III) aged 38-85 years.

MEASURES

PROMs EuroQoL 5D-5L (EQ-5D-5L) and Kansas City Cardiomyopathy Questionnaire and patient interview and observation.

RESULTS

A total of 20 patients with HFrEF participated in the study. The patients' mean (SD) age was 72.5 (11.4) years, 65% were male and were classified inNYHA functional classes I (n=4), II (n=7) and III (n=9). The study showed a strong impact of HF in the patients' quality of life (QoL) and disease experience, as revealed by the standardised PROMs (EQ-5D-5L global index=0.64 (0.36); Kansas City Cardiomyopathy Questionnaire total symptom score=71.56 (20.55)) and the in-depth interviews. Patients and caregivers often disagreed describing and evaluating perceived QoL, as patients downplayed their limitations and caregivers overemphasised the poor QoL of the patients. Patients related current QoL to distant life experiences or to critical moments in their disease, such as hospitalisations. Anxiety over the disease progression is apparent in both patients and caregivers, suggesting that caregiver-specific tools should be developed.

CONCLUSIONS

PROMs are an effective way of assessing symptoms over the most recent time period. However, especially in chronic diseases such as HFrEF, PROM scores could be complemented with additional tools to gain a better understanding of the patient's status. New PROMs designed to evaluate and compare specific points in the life of the patient could be clinically more useful to assess changes in health status.