Patient preferences for heart failure education and perceptions of patient–provider communication

Patients with Heart Failure: Internet Use and Mobile Health Perceptions

BACKGROUND

 Heart failure is a complex clinical syndrome noted on approximately one in eight death certificates in the United States. Vital to reducing complications of heart failure and preventing hospital readmissions is adherence to heart failure self-care routines. Mobile health offers promising opportunities for enhancing self-care behaviors by facilitating tracking and timely reminders.

OBJECTIVES

 We sought to investigate three characteristics of heart failure patients with respect to their heart failure self-care behaviors: (1) internet use to search for heart failure information; (2) familiarity with mobile health apps and devices; and (3) perceptions of using activity trackers or smartwatches to aid in their heart failure self-care.

METHODS

 Forty-nine heart failure patients were asked about their internet and mobile health usage. The structured interview included questions adapted from the Health Information National Trends Survey.

RESULTS

 Over 50% of the patients had utilized the internet to search for heart failure information in the past 12 months, experience using health-related apps, and thoughts that an activity tracker or smartwatch could help them manage heart failure. Qualitative analysis of the interviews revealed six themes: trust in their physicians, alternatives to mobile health apps, lack of need for mobile health devices, financial barriers to activity tracker and smartwatch ownership, benefits of tracking and reminders, and uncertainty of their potential due to lack of knowledge.

CONCLUSION

 Trust in their physicians was a major factor for heart failure patients who reported not searching for health information on the internet. While those who used mobile health technologies found them useful, patients who did not use them were generally unaware of or unknowledgeable about them. Considering patients' preferences for recommendations from their physicians and tendency to search for heart failure information including treatment and management options, patient-provider discussions about mobile health may improve patient knowledge and impact their usage.

Predictive models for delay in medical decision-making among older patients with acute ischemic stroke: a comparative study using logistic regression analysis and lightGBM algorithm

OBJECTIVE

To explore the factors affecting delayed medical decision-making in older patients with acute ischemic stroke (AIS) using logistic regression analysis and the Light Gradient Boosting Machine (LightGBM) algorithm, and compare the two predictive models.

METHODS

A cross-sectional study was conducted among 309 older patients aged ≥ 60 who underwent AIS. Demographic characteristics, stroke onset characteristics, previous stroke knowledge level, health literacy, and social network were recorded. These data were separately inputted into logistic regression analysis and the LightGBM algorithm to build the predictive models for delay in medical decision-making among older patients with AIS. Five parameters of Accuracy, Recall, F1 Score, AUC and Precision were compared between the two models.

RESULTS

The medical decision-making delay rate in older patients with AIS was 74.76%. The factors affecting medical decision-making delay, identified through logistic regression and LightGBM algorithm, were as follows: stroke severity, stroke recognition, previous stroke knowledge, health literacy, social network (common factors), mode of onset (logistic regression model only), and reaction from others (LightGBM algorithm only). The LightGBM model demonstrated the more superior performance, achieving the higher AUC of 0.909.

CONCLUSIONS

This study used advanced LightGBM algorithm to enable early identification of delay in medical decision-making groups in the older patients with AIS. The identified influencing factors can provide critical insights for the development of early prevention and intervention strategies to reduce delay in medical decisions-making among older patients with AIS and promote patients' health. The LightGBM algorithm is the optimal model for predicting the delay in medical decision-making among older patients with AIS.

Use of podcasts for health education: a scoping review

OBJECTIVES

to map the scientific evidence related to the characteristics, themes, and outcomes of using health education podcasts aimed at individuals over 18 years of age in intra or extrahospital environments.

METHODS

a scoping review, based on the Joanna Briggs Institute method, conducted in 11 databases, including studies from 2004 to 2022.

RESULTS

11 studies were selected, categorized, highlighting the characteristics, evaluated outcomes, areas, and conditions of podcast application, indicating it as an effective tool for promoting behavioral change, health promotion, and social interaction, demonstrating its potential to improve well-being, quality of life, and user/client autonomy.

CONCLUSIONS

the use of podcasts proves to be an effective, innovative, and low-cost tool, with a significant social impact, being effective for behavioral change, satisfaction, and social interaction. However, the lack of comprehensive studies on podcast development methodologies represents challenges to be overcome.

Actual status of pre-discharge knowledge of hospitalised patients with heart failure and measurement tools to assess said knowledge: A scoping review

BACKGROUND

Heart failure (HF) patients have high readmission rates and require continuous adherence to HF self-care. Lack of knowledge about HF has been identified as a factor that contributes to poor adherence.

OBJECTIVES

To clarify and organise existing data about measurement tools used to assess pre-discharge knowledge of hospitalised HF patients, the content and level of pre-discharge knowledge, factors associated with the level of knowledge, and the effect of knowledge levels on patients' outcomes.

METHODS

Four electronic databases were searched for articles that described the content and level of knowledge of pre-discharge HF patients.

RESULTS

Thirty-three studies were included in this review. Twenty-two measurement tools were identified used for pre-discharge knowledge assessment. 'Heart failure pathophysiology and treatment' and 'salt and fluid management' were the most common knowledge content measured. The level of knowledge of 'the nature, definition, and causes of symptoms of heart failure' and 'fluid and medication management' tended to be low. High levels of knowledge were found for 'higher educational background', 'previous heart failure hospitalisation', and 'previous heart failure education', while low levels were found for: 'high number of medications' and 'first heart failure hospitalisation'. The level of HF knowledge implies an impact on compliance and self-care.

CONCLUSION

HF patients have low level of knowledge of the nature and causes of HF and fluid management prior to hospital discharge. Some of the variables that influenced the level of patient knowledge were educational background, number of medications taken, and disease duration.

Inpatient vs. Outpatient: A Systematic Review of Information Needs throughout the Heart Failure Patient Journey

The objective of this systematic review was to identify and describe information needs for individuals with heart failure (HF) throughout their patient journey. Six databases were searched (APA PsycINFO, CINAHL Ultimate, Embase, Emcare Nursing, Medline ALL, and Web of Science Core Collection) from inception to February 2023. Search strategies were developed utilizing the PICO framework. Potential studies of any methodological design were considered for inclusion through a snowball hand search. Data from the included articles were extracted by a reviewer, and the extraction accuracy was independently cross-checked by another author. Quality appraisal was assessed using the Mixed-Methods Appraisal Tool. A narrative synthesis was used to analyze all the outcomes according to the Synthesis Without Meta-analysis reporting guidelines. Twenty-five studies (15 quantitative and 10 qualitative) were included. Socioeconomic, cultural, and demographic factors influencing information needs were considered. The top three information needs for outpatients included general HF information, signs and symptoms and disease management strategies. For inpatients, medications, risk factors, and general HF were reported as the top needs. These divergent needs emphasize the importance of tailored education at different stages. Additionally, the review identified gaps in global representation, with limited studies from Africa and South America, underscoring the need for inclusive research. The findings caution against overgeneralization due to varied reporting methods. Practical implications call for culturally sensitive interventions to address nuanced HF patients' needs, while future research must prioritize standardized reporting, consider diverse patient journey timepoints, and minimize biases for enhanced reliability and applicability.

Patientology revisited: Toward tailored care pathways

BACKGROUND

Concepts such as patient-centred care, patient empowerment and patient participation have challenged our understanding of what it means to be a patient and what role patients play in care pathways. Consequently, patientology as the medical sociological and anthropological study of patients is currently being reconceptualized through perspectives of health as individualized and privatized capital.

AIMS

This article explores the potential of such a patientological perspective to enhance our understanding of and tailor care pathways. Particularly, we aim to investigate how such a perspective can contribute to tailoring care pathways to the capacities of individual patients and their relatives.

MATERIALS & METHODS

We elaborate on an emerging health capital-theoretic model for patientology and study its potential for optimizing care pathways through two distinct cases of care contexts: communicative challenges in the context of integrative primary care for vulnerable chronically ill multi-morbid patients and the potential of parent involvement in the acute hospitalization of children suspected to be affected by multisystem inflammatory syndrome in children.

RESULTS

Our results shed light on the importance of cultural and social capital of patients and their relatives in the design of effective tailored care pathways. We find that a lack of cultural and social capital presents a significant barrier to effective communication between patients and the healthcare professionals involved in their care pathways. We also find that understanding the cultural and social capital of relatives provides an entry point to their effective involvement in the care pathways of their children.

DISCUSSION & CONCLUSION

The implications of these findings extend beyond the concrete care contexts studied. This article contributes to our understanding of care pathways through a perspective of health inequalities being based on differences in health capital and demonstrates how the health capital-theoretic patientology model facilitates the systematic development of guidelines for healthcare professionals to assess patients' resources and tailor their care pathways accordingly.

Decisional Needs and Patient Treatment Preferences for Heart Failure Medications: A Scoping Review

Background

Pharmacologic management of heart failure with reduced ejection fraction (HFrEF) involves several medications. Decision aids informed by patient decisional needs and treatment preferences could assist in making HFrEF medication choices; however, these are largely unknown.

Methods

We searched MEDLINE, Embase, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL), without language restriction, for qualitative, quantitative, and mixed-method studies that included patients with HFrEF or clinicians providing HFrEF care, and reported data on decisional needs or treatment preferences applicable to HFrEF medications. We classified decisional needs using a modified version of the Ottawa Decision Support Framework (ODSF).

Results

From 3996 records, we included 16 reports describing 13 studies (n = 854). No study explicitly assessed ODSF decisional needs; however, 11 studies reported ODSF-classifiable data. Patients commonly reported having inadequate knowledge or information, and difficult decisional roles. No study systematically assessed treatment preferences, but 6 studies reported on attribute preferences. Reducing mortality and improving symptoms frequently were ranked as being important, whereas cost importance rankings varied, and adverse events generally were ranked as being less important.

Conclusion

This scoping review identified key decisional needs regarding HFrEF medications, notably inadequate knowledge or information, and difficult decisional roles, which can readily be addressed by decision aids. Future studies should systematically explore the full scope of ODSF-based decisional needs in patients with HFrEF, along with relative preferences among treatment attributes to further inform development of individualized decision aids.

COMPETENCIES AND SKILLS NEEDED IN THE MANAGEMENT OF CHRONIC PATIENTS' NEEDS THROUGH TELECARE

OBJECTIVE

Aim: To identify the necessary competencies that future professionals must obtain in order to effectively manage patients with chronic conditions. We employed a multilayer review in PubMed, Scopus and Cochrane.

PATIENTS AND METHODS

Materials and Methods: We applied three searches in PubMed, Scopus, and Cochrane using various terms in order to identify the necessary skills and competences needed for healthcare professionals to provide distance care in patients with chronic conditions. From the initial search, a total of 1008 studies were identified while 54 met the inclusion criteria and were retained for data extraction. After the review of the 54 studies, we grouped the proposed skills and competencies in eight major categories. Those groups were Clinical Knowledge, Critical Thinking Skills, Technological Skills, Clinical skills, Communication skills, Implementation skills, Professionalism and professional ethics, Evidence based Practice.

CONCLUSION

Conclusions: Although telehealth is gaining ground in healthcare practice and healthcare professionals possess the necessary knowledge and skills to provide safe, effective, and personalized care, additional specialized training is nevertheless required to provide telecare. Therefore, the integration of telehealth into various healthcare professions curricula - both at undergraduate and postgraduate levels - is required for the development of education and the dynamic development of healthcare.

Predictors of Unrelieved Symptoms in All of Us Research Program Participants With Chronic Conditions

CONTEXT

Over half of American adults are diagnosed with a chronic condition, with an increasing prevalence being diagnosed with multiple chronic conditions. These adults are at higher risk for having unrelieved, co-occurring symptoms, known as symptom clusters.

OBJECTIVES

To identify symptom phenotypes of patients diagnosed with four common chronic conditions, specifically, cancer, chronic obstructive pulmonary disease, heart failure, and/or type 2 diabetes mellitus, and to understand factors that predict membership in symptomatic phenotypes.

METHODS

We conducted a retrospective, cross-sectional analysis using participant responses (N=14,127) to All of Us Research Program, a National Institutes of Health biomedical database, survey questions. We performed hierarchical clustering to generate symptom phenotypes of fatigue, emotional distress, and pain and used multinomial regression to determine if demographic, healthcare access and utilization, and health-related variables predict symptom phenotype.

RESULTS

Four phenotypes, one asymptomatic or mildly symptomatic and three highly symptomatic (characterized by severe symptoms, severe pain, and severe emotional distress), were identified. The percentage of participants belonging to the severe symptoms phenotype increased with the number of chronic conditions. Most notably, foregoing or delaying medical care and rating mental health as poor or fair increased the odds of belonging to a highly symptomatic phenotype.

CONCLUSION

We found meaningful relationships between demographic, healthcare access and utilization, and health-related factors and symptom phenotypes. With the increasing trends of American adults with one or more chronic conditions and a demand to individualize care in the precision health era, it is critical to understand the factors that lead to unrelieved symptoms.

Communication about medication management during patient-physician consultations in primary care: a participant observation study

OBJECTIVE

To explore communication about medication management during annual consultations in primary care.

DESIGN

passive participant observations of primary care consultations.

SETTING

Two primary care centres in southern Sweden.

PARTICIPANTS

Consultations between 18 patients (over the age of 60 years) with chronic diseases and 10 general practitioners (GPs) were observed, audio-recorded, transcribed and analysed using content analysis.

RESULTS

Four categories emerged: communication barriers, striving for a shared understanding of medication management, evaluation of the current medication treatment and the plan ahead and behavioural changes in relation to medication management. Misunderstandings in communication, failure to report changes in the medication treatment and use of generic substitutes complicated mutual understanding and agreement on continued treatment. The need for behavioural changes to reduce the need for medication treatment was recognised but should be explored further.

CONCLUSION

Several pitfalls, including miscommunication and inaccurate medication lists, for safe medication management were identified. The purpose of annual consultations should be clarified, individual treatment plans could be used more actively during primary care consultations and efforts are needed to improve verbal communication and information continuity.

The Situation-Specific Theory of Heart Failure Self-care: An Update on the Problem, Person, and Environmental Factors Influencing Heart Failure Self-care

Many studies of heart failure (HF) self-care have been conducted since the last update of the situation-specific theory of HF self-care.

OBJECTIVE

The aim of this study was to describe the manner in which characteristics of the problem, person, and environment interact to influence decisions about self-care made by adults with chronic HF.

METHODS

This study is a theoretical update. Literature on the influence of the problem, person, and environment on HF self-care is summarized.

RESULTS

Consistent with naturalistic decision making, the interaction of the problem, person, and environment creates a situation in which a self-care decision is needed. Problem factors influencing decisions about HF self-care include specific conditions such as cognitive impairment, diabetes mellitus, sleep disorders, depression, and symptoms. Comorbid conditions make HF self-care difficult for a variety of reasons. Person factors influencing HF self-care include age, knowledge, skill, health literacy, attitudes, perceived control, values, social norms, cultural beliefs, habits, motivation, activation, self-efficacy, and coping. Environmental factors include weather, crime, violence, access to the Internet, the built environment, social support, and public policy.

CONCLUSIONS

A robust body of knowledge has accumulated on the person-related factors influencing HF self-care. More research on the contribution of problem-related factors to HF self-care is needed because very few people have only HF and no other chronic conditions. The research on environment-related factors is particularly sparse. Seven new propositions are included in this update. We strongly encourage investigators to consider the interactions of problem, person, and environmental factors affecting self-care decisions in future studies.

CE: Guideline-Directed Cardiac Devices for Patients with Heart Failure

ABSTRACT

Heart failure affects over 6.2 million adults in the United States and is expected to affect over 8 million by 2030. The U.S. one-year mortality rate is almost 30% among Medicare beneficiaries. Technological advances have produced several new cardiac devices that are available for therapy and symptom management. This article reviews current device therapies for heart failure and uses a composite case to demonstrate how bedside nurses can help patients understand treatment options related to their disease process and care for them through this experience.

Development of Core Educational Content for Heart Failure Patients in Transition from Hospital to Home Care: A Delphi Study

Heart failure (HF) patients should be systematically educated before discharge on how to manage with standard written materials for patient self-management. However, because of the absence of readily available written materials to reinforce their learned knowledge, patients with HF feel inadequately informed in terms of the discharge information provided to them. This study aimed to develop core content to prepare patients with HF for transition from hospital to home care. The content was validated by expert panelists using Delphi methods. Nineteen draft items based on literature review were developed. We established a consensus on four core sections, including 47 categories and 128 subcategories through the Delphi survey: (1) understanding HF (five categories and 23 subcategories), (2) HF medication (19 categories and 45 subcategories), (3) HF management (20 categories and 47 subcategories), and (4) HF diary (three categories and 13 subcategories). Each section provided easy-to-understand educational contents using cartoon images and large or bold letters for older patients with HF. The developed core HF educational contents showed high consensus between the experts, along with clinical validity. The contents can be used as an educational booklet for both planning discharge education of patients with HF and for post-discharge management when transitioning from hospital to home. Based on this study, a booklet series for HF patients was first registered at the National Library of Korea. Future research should focus on delivering the core content to patients with HF in convenient and accessible format through various media.

Patient educational needs and challenges in psoriatic arthritis

PURPOSE OF REVIEW

To provide an overview of the recent research publications on educational needs of patients with psoriatic arthritis (PsA) and the associated challenges.

RECENT FINDINGS

The rate of good treatment adherence in PsA can be as low as 57.7% and successful patient education can help improve treatment adherence. Also, 78.7% of patients who stopped their disease modifying anti-rheumatic drugs during the first wave of the COVID-19 pandemic did so without the advice of their clinician. In delivering educational needs, the aspects of disease process, treatment, self-help measures, managing pain, movement, psychological and social needs should all be addressed, whilst at the same time, recognising that PsA patients with multidomain disease, are likely to be dealing with more than just pain. Arthritis self-care management education is potentially beneficial, but up to 11% of educational YouTube videos may contain misleading patient opinion and many existing apps do not meet the needs of the patients with PsA.

SUMMARY

Significant room for improvement exists in treatment adherence in PsA and patient education addressing the relevant educational needs could assist with this issue. However, patients should be advised to be wary of internet videos and other educational aids that were not created by health professionals.

Filling a gap in standardized nursing terminology. Development of a new nursing diagnosis proposal on heart failure self-care

PURPOSE

Heart failure is a highly prevalent chronic health problem associated with poor quality-of-life and negative outcomes. Self-care is a cornerstone in patients suffering from heart failure. Nurses are commonly engaged in enhancing patients' self-care behaviors, but the specific condition of deficit on self-care is not clearly identified by nurses. No nursing diagnoses focused on self-care of heart failure patients is currently available. This study aimed to develop a new nursing diagnosis that focuses on self-care in heart failure patients.

DATA SOURCES

A concept and content analysis were used. Some steps of the concept analysis were performed through an integrative literature review conducted searching in PUBMED and CINAHL databases to identify attributes, antecedents, and consequences of the diagnosis. Forty-five articles were selected from the 1450 studies found. Then, the content analysis was performed by an international panel of 29 experts. Two Delphi rounds were used to achieve consensus and an item content validity index was calculated for each diagnostic element.

DATA SYNTHESIS

Integrative review proposed four diagnostic labels, two definitions, 15 defining characteristics, and 44 related factors. After the two Delphi rounds a consensus was reached for each diagnostic indicator with a content validity index ranging from 82.8% to 100%. The nursing diagnosis-labeled heart failure self-care deficit-was validated with a definition, eight defining characteristics, 15 related factors, and five at-risk populations.

CONCLUSIONS

This diagnosis allows nurses to document patients' self-care in daily clinical practice through a standard nursing terminology, by naming this health problem, describing its etiology, and clinical manifestations.

IMPLICATIONS FOR NURSING PRACTICE

This new diagnosis is expected to assist nursing clinicians, educators, and students in clinical reasoning with the aim to improve diagnostic accuracy in identifying patients with a heart failure self-care deficit, to select the most appropriate interventions and pursue better outcomes.

Nursing-Based Guidelines for Caregivers regarding Adult Patients with Percutaneous Endoscopic Gastrostomy

Background:

Percutaneous Endoscopic Gastrostomy (PEG) may cause complications when the management is inadequate and inappropriate. To avoid these complications, caregivers’ experiences and practices must be considered.

Study Aim:

This study aimed to evaluate the effect of nursing- based guidelines on caregivers’ knowledge and practices regarding adult patients with percutaneous endoscopic gastrostomy.

Methods:

A quasi-experimental design was used. The study was conducted in the medical and surgical departments in the National Cancer Institute, Cairo University, Egypt. Sample: The sample consisted of 30 patients with PEG and their caregivers. A Structured interviewing questionnaire, Self-Administered Structured Questionnaire for caregiver, Caregiver Performance observation checklist, and PEG-specific questionnaire were obtained for data collection

Results:

The majority of studied patients (86.7%) were suffering from oncologic problems, in post-test and following up, the majority (83.3%) of caregivers had satisfactory level (76.7) (90%) (70%) in knowledge, complication and management of PEG, respectively. During follow up, the majority (73.3%) (90%) of caregivers were well level as regarding nutritional management and care of PEG. There were statistically significant differences between pre/post and follow-up nursing-based guidelines for caregivers’ knowledge and practice regarding patients with percutaneous endoscopic gastrostomy. The results show an improvement in the patients outcomes and the level of caregiver coping with the care of PEG and overall Patient satisfaction at (χ2 = 3.844, 4.097) p<0.001

Conclusion:

Nursing-based guidelines were helpful in the improvement of the caregiver's knowledge and practice regarding percutaneous endoscopic gastrostomy.

Recommendations

Periodic educational training programs regarding PEG were based on the best practice guidelines for caregivers of those patients.