The role of nursing in managing treatment-associated adverse effects in patients with hepatitis C

Experiences of UK patients with hepatitis C virus infection accessing phlebotomy: A qualitative analysis

This study provides an understanding of the experiences and perceptions of phlebotomy in people with infection who have venous damage related to injecting drug use with the aim of improving their care. Narrative interviews were conducted with 10 attendees of a phlebotomy service within an acute Trust in the south-west of England. The participants had hepatitis C infection and poor venous access due to current or former drug use. Interview audiotapes were analyzed, and the themes - conflict, emotional responses, the patient as expert, and offering solutions - were identified. In the context of this study, we discuss the difficulties associated with phlebotomy, which might explain why individuals with hepatitis C infection and venous damage disengage from health services and are less likely to undertake antiviral treatment. This research adds to the literature on phlebotomy for vulnerable groups, and recommends hepatitis C virus clinics within drug agencies, the need to review training and policy, and the development of "phlebotomy passports" to enable continuity of care between services.

Hepatitis C in European prisons: a call for an evidence-informed response

Globally, over 10 million people are held in prisons and other places of detention at any given time. People who inject drugs (PWID) comprise 10-48% of male and 30-60% of female prisoners. The spread of hepatitis C in prisons is clearly driven by injection drug use, with many infected prisoners unaware of their infection status. Risk behaviour for acquisition of hepatitis C via common use of injecting equipment is widespread in many prison settings. In custodial settings, effective and efficient prevention models applied in the community are very rarely implemented. Only approximately 60 out of more than 10,000 prisons worldwide provide needle exchange. Thus, HCV prevention is almost exclusively limited to verbal advice, leaflets and other measures directed to cognitive behavioural change. Although the outcome of HCV antiviral treatment is comparable to non-substance users and substance users out of prison, the uptake for antiviral treatment is extremely low. Based on a literature review to assess the spread of hepatitis C among prisoners and to learn more about the impact for the prison system, recommendations regarding hepatitis C prevention, screening and treatment in prisons have been formulated in this article.

Developing the Australasian Hepatology Association's Consensus-based Guidelines for the Nursing Care of Patients with Liver Disease

Abstract Purpose: Hepatology nursing is an emerging speciality. To define best practice, the Australasian Hepatology Association developed consensus-based guidelines for the nursing care of patients with liver disease. Methods: Using the Delphi technique, six rounds of consultation were conducted with Australian hepatology nurses and non-nursing hepatology professionals. Input was captured through face-to-face and electronic communication and questionnaires. Results: The experts' opinions were collated and consensus on the delivery of hepatology nursing care was achieved. In total, 90 consensus guidelines were developed. The principles underpinning the Guidelines include patient-centred care, non-discriminatory practice, cultural competence, collaboration and partnership and working within own scope of practice. Conclusion: Internationally, the Australasian Hepatology Association Guidelines are the first to document a consensus on the scope of hepatology nursing practice. The Guidelines reflect the expansion of hepatology nursing, from viral hepatitis to caring for patients with advanced liver disease and hepatocellular carcinoma, and provides a framework for future nursing practice.

"It's a big part of our lives": A qualitative study defining quality of hepatitis C care from the patient's perspective

Nurses play a key role in the ongoing treatment and management of chronic conditions such as Hepatitis C. Their skills in counseling, education, and as liaisons between patients, support services, and other healthcare providers make them crucial in the management of patients with Hepatitis C. Qualitative methods were used to explore and describe quality-of-care perspectives of patients receiving care in viral hepatitis clinics. Data were collected through focus group interviews at three hepatitis prevention and care demonstration projects located in underserved rural and small urban areas in British Columbia, Canada. Key themes were identified and used to construct a "Hepatitis C care model" and generate quality-of-care statements. These statements were then rated by another group of participants with Hepatitis C, using concept mapping. Most themes identified by the participants in focus groups (n = 21) related to care provision processes (autonomy, communication, education/information, continuity of care, professional competence, and support) rather than structure or outcomes of care. Concept-mapping participants (n = 20) rated communication as the key theme. Participants also highlighted the supportive role nurses played. Hepatitis C programming can be improved by leveraging nurses' strengths within multidisciplinary teams to address patient's concerns about process and communication issues.

The lived experience of treatment for hepatitis C

The purpose of this qualitative study was to explore and describe male patients' experiences of undergoing and completing treatment for the hepatitis C virus. A qualitative, descriptive, and phenomenological methodology was used. Eight male patients diagnosed with the hepatitis C virus, aged 41-60 years and enrolled in a health maintenance organization, were interviewed in their private residences in a community setting. In depth, semistructured, tape-recorded, and transcribed interviews were analyzed by using theme coding. Six themes emerged that described the lived experience of male patients after undergoing treatment for the hepatitis C virus: acquisition of the disease, the diagnosis, the treatment decision making, the "horror stories" regarding treatment, what helped, and feelings now.Patients who are diagnosed with the hepatitis C virus and undergo treatment face a difficult therapy regimen. All participants knew how they acquired the disease and had no sense of apology for how they attracted it. Their only goal was to achieve viral clearance of this disease. Treatment was their option. Nurses play a key role in the management of treatment for patients undergoing therapy for hepatitis C. The management of the adverse effects of therapy has a great impact on patients' quality of life and compliance with the therapy. Nurses are able to help patients by recognizing and managing the adverse effects of this therapy.

Neuropsychiatric symptoms of hepatitis C

More than 4 million (2%) people in the United States have been infected with the hepatitis C virus, of whom 2.7 million are chronically infected. The current treatment for chronic hepatitis C patients is Interferon and ribavirin combination therapy, which is associated with numerous neuropsychiatric side effects. The most common are fatigue, depression, cognitive dysfunction, and anxiety. Early identification and treatment of these symptoms may not only improve the patient's mental health, but also may increase the patient's functional ability and overall quality of life. Psychiatric nurses can play a pivotal role in the successful management of the neuropsychiatric symptoms.

Pretreatment preparation and management of interferon-based therapy for hepatitis C virus infection

AIM

This paper is a report of a study to explore how healthcare professionals prepare patients for hepatitis C treatment and the management strategy used during this treatment.

BACKGROUND

A high proportion of patients receiving hepatitis C treatment has dose reductions or discontinues treatment because of adverse events arising from the therapeutic drugs.

METHOD

An exploratory study was carried out in Australia in 2004 and 2005 using semi-structured interviews with a sample of six healthcare professionals with experience in managing hepatitis C treatment regimens.

FINDINGS

Participants reported that pretreatment preparation focused on information provision regarding the adverse events and the medical strategies that could ameliorate their impact. Patients' vulnerabilities and supports were assessed prior to treatment and healthcare professionals sought to address patients' problems as they arose during treatment. Participants discussed patients' resilient coping style and the beneficial impact this had on treatment management.

CONCLUSION

Among our sample, a deficits-based approach was taken to hepatitis C treatment management. While some attempts were made to assess patients' strengths, these were limited to identifying those in family, work and social networks who could lend support to patients when problems occurred. Exploring patients' past experiences of adversity and making a detailed evaluation of a range of patients' strengths might assist clinicians in managing hepatitis C treatment regimens.

Physicians, Nonphysician Healthcare Providers, and Patients Communicating in Hepatitis C

In-office conversations about hepatitis C can impact patients' perceptions of outcomes, as well as medication adherence. This study analyzed interactions between physicians, nonphysician healthcare providers (including nurses), and patients with hepatitis C virus infection in order to examine differences based on number and type of providers participating. Gastroenterologists, nonphysician healthcare providers, and patients with hepatitis C virus infection were video- and audio-recorded during regularly scheduled visits. Recordings were transcribed and analyzed using validated sociolinguistic techniques. Thirty-four visits took place with a physician only, 4 with a nonphysician healthcare provider only, and 25 with both providers (9 concurrent and 16 consecutive). Differences among the participant schema included visit length, patient "talk-time," and motivation provided. When providers saw patients consecutively, differing information was sometimes provided. In visits where providers saw the patient concurrently, competing authority between providers and exclusion of the patient through use of medical jargon were obstacles to ideal communication. Differences in hepatitis C-related interactions based on the number and type of participants suggest opportunities for improved communication. In visits with multiple providers, physicians and nurses should attempt to ensure that they (a) avoid supplying differing information, (b) present a "unified front" to avoid competing authority, and (c) minimize the use of medical jargon, which excludes patients from participating in their own healthcare.

Peginterferon Alpha/Ribavirin Combination Therapy for the Treatment of Hepatitis C Infection

Chronic infection with the hepatitis C virus is widespread in the United States. This disease is associated with a progression of fibrosis of the liver leading to liver cirrhosis in as many as 20% of cases. The current standard of care for the treatment of chronic hepatitis C infection is combination therapy with pegylated interferon alpha plus ribavirin. In more than 50% of patients, this regimen has been shown to induce a sustained viral response, defined as undetectable hepatitis C viral ribonucleic acid (RNA) for 6 months after the end of treatment. Typically, patients are treated for 24 or 48 weeks. A number of possible adverse events are associated with combination therapy, and patient empowerment through supportive nursing care is critical to facilitating patient adherence to treatment. This article provides an update on information concerning the diagnosis and treatment of chronic hepatitis C infection. This information can be tailored to provide patient-focused assessment, education, and treatment.

A Clarified Conceptual Meaning of Hepatitis C-Related Depression

A clarified conceptual meaning of depression in individuals with hepatitis C virus infection is proposed based on a critical review of literature. Moving beyond an exclusively biomedical perspective, depression in hepatitis C is explained by a cluster of factors that incorporate physiological, psychological, and social dimensions. Symptom experience, stigma, and uncertainty are factors that span the complex nature of depression in individuals with hepatitis C. This broadened perspective incorporates individual and societal values and beliefs regarding hepatitis C and encompasses the multidimensional complexity of depression in hepatitis C. Hepatitis C-related depression presents an enormous challenge for nurses because of its interference with treatment adherence and significant negative impact on the individual's quality of life. Nursing theorists, researchers, and clinicians may benefit from a clear conceptual understanding of the unique nature of depression in this growing segment of the U.S. population. This clarified conceptual meaning needs to be validated through qualitative, quantitative, and longitudinal studies with this population. It is hoped that future theorists, researchers, and practitioners will contribute to our conceptual understanding, resulting in improved quality of life for this special population.

A descriptive study of the relationship between mood disorders and hepatitis C treatment compliance: does nursing play a role?

Chronic hepatitis C is a common and often serious condition. Current treatment uses antiviral therapy based on alpha interferon. Neuropsychiatric side effects are common with interferon therapy, and the management of mood disorders during treatment for hepatitis C is an important part of helping patients maintain compliance, thus improving their chance of having a successful treatment outcome. This descriptive study examined the incidence of mood disorders in 29 treatment naïve patients with chronic hepatitis C participating in a clinical trial of various interferon-based therapies. Relationships among mood disorders, use of antidepressants, hepatitis treatment compliance, and sustained treatment response (having undetectable hepatitis C viral load 24 weeks post-treatment) were examined. Eighty-one percent of sustained responders experienced psychiatric events, and it is speculated that comprehensive nursing support and intervention were key components in achieving favorable patient outcomes.