1
|
Brown J, Cox L, Mulligan K, Wilson S, Heys M, Livermore P, Gray S, Bogosian A. Gaining consensus on emotional wellbeing themes and preferences for digital intervention type and content to support the mental health of young people with long-term health conditions: A Delphi study. Health Expect 2024; 27:e14025. [PMID: 38591848 PMCID: PMC11003273 DOI: 10.1111/hex.14025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/21/2024] [Accepted: 03/07/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Young people (YP) with long-term conditions (LTCs) are at greater risk of psychological distress than those without LTCs. Despite this, there is a scarcity of quality digital interventions designed to help improve mental wellbeing in this population. The aim of this study was to determine what YP, parents and health professionals preferred for future interventions. METHODS Twenty-six YP with asthma, diabetes and/or epilepsy (the three most common LTCs in YP), 23 parents of YP with LTCs and 10 health professionals mainly in paediatric specialisms (total n = 59) took part in an online Delphi study to gain consensus (set at 75% agreement) on four questions across three rounds. Participants ordered psychological themes that may be experienced by YP with LTCs by importance and ranked digital intervention types and delivery modes by importance or usefulness. The most common results were reported if no consensus was reached by round 3. RESULTS Participants preferred a mobile phone app (73% agreement) and a mixture of one-on-one and group support for an intervention (75% agreement). The two highest ranked psychological themes were anxiety (44%) and wanting to appear 'normal' (38%), and the top intervention type was 'general counselling' (54% agreement). CONCLUSION There was a clear desire for an app to help with the psychological aspects of living with LTCs and for a combination of one-to-one and group intervention elements. Anxiety and wanting to appear 'normal' might be two closely linked psychological challenges that could be addressed by a single intervention. IMPLICATIONS The results will be important to consider for a future intervention, although further consultation will be needed for app development. PATIENT OR PUBLIC CONTRIBUTION Two YP with a LTC provided feedback on the study protocol including the aims and procedures of the project. Another six YP with LTCs were consulted on an early draft of the study questionnaire (the four questions), which was subsequently revised. Once the project began, a patient and public involvement group consisting of two YP with LTCs and one parent of a YP with an LTC gave feedback on the research process, lay report of the results and dissemination plan.
Collapse
Affiliation(s)
- Jennie Brown
- School of Health and Psychological SciencesCity University of LondonLondonUK
| | - Lauren Cox
- School of Health and Psychological SciencesCity University of LondonLondonUK
| | - Kathleen Mulligan
- School of Health and Psychological SciencesCity University of LondonLondonUK
| | - Stephanie Wilson
- School of Mathematics, Computer Science and EngineeringCity University of LondonLondonUK
| | - Michelle Heys
- East London NHS Foundation TrustLondonUK
- Population, Policy and Practice DepartmentUniversity College LondonLondonUK
| | - Polly Livermore
- Great Ormond Street Institute of Child Health (GOS ICH)LondonUK
| | - Suzy Gray
- Great Ormond Street Institute of Child Health (GOS ICH)LondonUK
| | - Angeliki Bogosian
- School of Health and Psychological SciencesCity University of LondonLondonUK
| |
Collapse
|
2
|
Antonio MG, Veinot TC. From illness management to quality of life: rethinking consumer health informatics opportunities for progressive, potentially fatal illnesses. J Am Med Inform Assoc 2024; 31:674-691. [PMID: 38134954 PMCID: PMC10873853 DOI: 10.1093/jamia/ocad234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/31/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVES Investigate how people with chronic obstructive pulmonary disease (COPD)-an example of a progressive, potentially fatal illness-are using digital technologies (DTs) to address illness experiences, outcomes and social connectedness. MATERIALS AND METHODS A transformative mixed methods study was conducted in Canada with people with COPD (n = 77) or with a progressive lung condition (n = 6). Stage-1 interviews (n = 7) informed the stage-2 survey. Survey responses (n = 80) facilitated the identification of participants for stage-3 interviews (n = 13). The interviews were thematically analyzed. Descriptive statistics were calculated for the survey. The integrative mixed method analysis involved mixing between and across the stages. RESULTS Most COPD participants (87.0%) used DTs. However, few participants frequently used DTs to self-manage COPD. People used DTs to seek online information about COPD symptoms and treatments, but lacked tailored information about illness progression. Few expressed interest in using DTs for self- monitoring and tracking. The regular use of DTs for intergenerational connections may facilitate leaving a legacy and passing on traditions and memories. Use of DTs for leisure activities provided opportunities for connecting socially and for respite, reminiscing, distraction and spontaneity. DISCUSSION AND CONCLUSION We advocate reconceptualizing consumer health technologies to prioritize quality of life for people with a progressive, potentially fatal illness. "Quality of life informatics" should focus on reducing stigma regarding illness and disability and taboo towards death, improving access to palliative care resources and encouraging experiences to support social, emotional and mental health. For DTs to support people with fatal, progressive illnesses, we must expand informatics strategies to quality of life.
Collapse
Affiliation(s)
- Marcy G Antonio
- School of Information, University of Michigan, Ann Arbor, MI 48109, United States
- School of Health Information Science, University of Victoria, Victoria, BC V8W 2Y2, Canada
| | - Tiffany C Veinot
- School of Information, University of Michigan, Ann Arbor, MI 48109, United States
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI 48109, United States
| |
Collapse
|
3
|
Siu DCH, Gafni-Lachter L. Addressing Barriers to Chronic Obstructive Pulmonary Disease (COPD) Care: Three Innovative Evidence-Based Approaches: A Review. Int J Chron Obstruct Pulmon Dis 2024; 19:331-341. [PMID: 38317666 PMCID: PMC10843977 DOI: 10.2147/copd.s426050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/17/2024] [Indexed: 02/07/2024] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a preventable yet widespread and profoundly debilitating respiratory condition, exerting substantial personal and global health ramifications alongside significant economic implications. The first objective of this literature review was to identify reviews the barriers to optimal COPD care, categorizing them into personal patient factors, professional awareness and knowledge, patient-professional relationships, and healthcare service models, including access to care that significantly impacts the quality of COPD management. The second objective was to introduce three approaches for enhancing COPD care outcomes: Self-Management Educational Programs, Health Qigong, and Telehealth service provision, each demonstrating positive effects on COPD patients' health status. These evidence-based interventions offer promising avenues for enhancing COPD care and patient outcomes. Integrating these approaches into comprehensive COPD management strategies holds potential for improving the well-being and quality of life of individuals living with this chronic condition.
Collapse
Affiliation(s)
- Damian Chi Hong Siu
- Boston University, Sargent College of Health and Rehabilitation Sciences, Boston, MA, USA
| | - Liat Gafni-Lachter
- Boston University, Sargent College of Health and Rehabilitation Sciences, Boston, MA, USA
| |
Collapse
|
4
|
Roberti JE, Alonso JP, May CR. Negotiating treatment and managing expectations in chronic kidney disease: A qualitative study in Argentina. Chronic Illn 2023; 19:730-742. [PMID: 36062573 DOI: 10.1177/17423953221124312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To describe how patients with CKD negotiated assigned responsibilities in the management of their disease, resulting in potential relational nonadherence. METHODS Qualitative study performed in two healthcare facilities in Buenos Aires, Argentina, including 50 patients and 14 healthcare providers. We conducted semistructured interviews which were analysed using a frame of reference with concepts of Burden of Treatment and Cognitive Authority theories. FINDINGS Adherence to treatment defined "good patients". Patients needed to negotiate starting treatment, its modality and dialysis schedule, although most patients felt they did not participate in the decision process and that providers did not acknowledge implications of these decisions on their routine. Some patients skipped dialysis if concerns were not attended. Regularly, patients negotiated frequency of visits, doses, dietary restrictions and redefined relationships with their support networks, sometimes with devasting effects. As a result of overwhelming uncertainty some patients refused enrolling into a transplant program. When the frequency of complications increased, patients considered abandoning dialysis. CONCLUSION When patients perceived demands were excessive or conflicting, they entered into negotiations. Relationally induced nonadherence may arise when professionals do not or cannot enter into negotiations over patients' beliefs or knowledge about what is possible for them to do.
Collapse
Affiliation(s)
- Javier E Roberti
- CIESP/CONICET, Buenos Aires, Argentina
- IECS, Buenos Aires, Argentina
| | - Juan P Alonso
- CIESP/CONICET, Buenos Aires, Argentina
- IECS, Buenos Aires, Argentina
| | - Carl R May
- London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
5
|
May CR, Chew-Graham CA, Gallacher KI, Gravenhorst KC, Mair FS, Nolte E, Richardson A. EXPERTS II - How are patient and caregiver participation in health and social care shaped by experienced burden of treatment and social inequalities? Protocol for a qualitative synthesis. NIHR OPEN RESEARCH 2023; 3:31. [PMID: 37881470 PMCID: PMC10593344 DOI: 10.3310/nihropenres.13411.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 10/27/2023]
Abstract
Background The workload health and social care service users and caregivers take on, and their capacity to do this work is important. It may play a key part in shaping the implementation of innovations in health service delivery and organisation; the utilisation and satisfaction with services; and the outcomes of care. Previous research has often focused on experiences of a narrow range of long-term conditions, and on factors that shape adherence to self-care regimes. Aims With the aim of deriving policy and practice implications for service redesign, this evidence synthesis will extend our understanding of service user and caregiver workload and capacity by comparing how they are revealed in qualitative studies of lived experience of three kinds of illness trajectories: long-term conditions associated with significant disability (Parkinson's disease, schizophrenia); serious relapsing remitting disease (Inflammatory Bowel Disease, bipolar disorder); and rapidly progressing acute disease (brain cancer, early onset dementia). Methods We will review and synthesise qualitative studies of lived experience of participation in health and social care that are shaped by interactions between experienced treatment burdens, social inequalities and illness trajectories. The review will involve: 1. Construction of a theory-informed coding manual; systematic search of bibliographic databases to identify, screen and quality assess full-text papers. 2. Analysis of papers using manual coding techniques, and text mining software; construction of taxonomies of service user and caregiver work and capacity. 3. Designing a model of core components and identifying common factors across conditions, trajectories, and contexts. 4. Work with practitioners, and a Patient and Public Involvement (PPI) group, to explore the validity of the models produced; to develop workload reduction strategies; and to consider person-centred service design. Dissemination We will promote workload reduction models to support service users and caregivers and produce policy briefs and peer-reviewed publications for practitioners, policy-makers, and researchers.
Collapse
Affiliation(s)
- Carl R May
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
- NIHR ARC North Thames, London, UK
| | | | | | - Katja C Gravenhorst
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
- NIHR ARC North Thames, London, UK
| | - Frances S Mair
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Ellen Nolte
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
- NIHR ARC North Thames, London, UK
| | - Alison Richardson
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR ARC Wessex, Southampton, UK
| |
Collapse
|
6
|
Chang EM, Chen LS, Li YT, Chen CT. Associations Between Self-Management Behaviors and Psychological Resilience in Patients With COPD. Respir Care 2023; 68:511-519. [PMID: 36854468 PMCID: PMC10173111 DOI: 10.4187/respcare.10416] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND COPD is a common but irreversible disease. Nevertheless, patients with COPD can maintain good quality of life through psychological resilience and effective self-management. However, limited studies have investigated the relationship between self-management behaviors and resilience in patients with COPD. Thus, the present study aimed to determine the factors associated with self-management behaviors and resilience among patients with COPD. METHODS A total of 100 subjects with COPD were recruited from a medical center in northern Taiwan from February 2020 to January 2021. Each subject completed a questionnaire based on the 20-item COPD Self-Management Scale and 25-item Resilience Scale through a face-to-face interview. A multiple linear regression model that controlled for sociodemographic and clinical factors was used to examine the relationship between self-management behaviors and resilience. RESULTS Analysis of our data indicated that differences in educational level, smoking status, religion, modified Medical Research Council dyspnea scale score, degree of COPD impacting wellbeing, number of COPD-related hospitalizations within 1 year, and self-reported comorbidities were associated with differences in self-management and resilience scores. The GOLD (Global Initiative for Chronic Obstructive Lung Disease) D group had the lowest scores for self-management and resilience among GOLD groups A, B, C, and D. Self-management and resilience were positively correlated (r = 0.703, P < .001). In the linear regression model, a better self-management value was associated with a higher resilience score (β = 0.749, P < .001), whereas an increasing resilience score was also associated with a better self-management score (β = 0.461, P < .001). CONCLUSIONS This study revealed that self-management and psychological resilience were positively correlated and associated in our linear regression model. Future work may focus on finding the causative relationship between self-management and resilience among patients with COPD.
Collapse
Affiliation(s)
- En-Ming Chang
- Department of Long-Term Care, National Taipei University of Nursing and Health Science, Taipei City, Taiwan
- Department of Respiratory Care, Shin Kong Wu Ho Su Memorial Hospital, Taipei City, Taiwan
| | - Li-Sheng Chen
- Department of Respiratory Therapy, Georgia State University, Atlanta, Georgia
| | - Yang-Tzu Li
- Department of Long-Term Care, National Taipei University of Nursing and Health Science, Taipei City, Taiwan
| | - Chi-Tsung Chen
- Department of Respiratory Care, Shin Kong Wu Ho Su Memorial Hospital, Taipei City, Taiwan.
| |
Collapse
|
7
|
Burden, depression and anxiety effects on family caregivers of patients with chronic kidney disease in Greece: a comparative study between dialysis modalities and kidney transplantation. Int Urol Nephrol 2023; 55:1619-1628. [PMID: 36720745 DOI: 10.1007/s11255-023-03482-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 01/21/2023] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Burden of caregivers is a status that was identified as a consequence of daily care. Anxiety and depression are probably related to complex tasks interwined with the care of a family member suffering from chronic kidney disease (CKD). PURPOSE To examine the experienced burden, anxiety and depression of Greek caregivers of patients with End-Stage CKD on dialysis as well as kidney transplant recipients (TX) in relation to their demographic profile and to compare among the groups. METHODS A total of 396 participants (198 couples of patients and caregivers) were recruited. Structured interviews and self-completed questionnaires were obtained from patients undergoing dialysis modalities as well as TX (28 peritoneal dialysis patients, 137 hemodialysis patients, 33 TX) and their caregivers. Zarit Burden Interview, Beck Depression Inventory and the Generalized Anxiety Disorder-2 scales were used as screening tools. RESULTS The majority of caregivers were females (67.2%), with a median age of 58 years. Total burden was indicated as mild to moderate (Mdn = 36 (24-51)). Caregivers of haemodialysis (HD) patients showed the highest burden (Mdn = 40 (26-53)) followed by peritoneal dialysis(PD) (Mdn = 29 (25-51)) and TX group (Mdn = 28 (21-43)) (p = 0.022). Caregivers' depression and anxiety were related to the type of patients' treatment, as well. Caregivers of HD and PD patients reported significantly higher depression (Mdn = 11 (5-18)) and anxiety scores (Mdn = 3 (2-5)) in comparison to TX caregivers (Mdn = 6 (2-13) and Mdn = 2 (2-4)) (p = 0.045 and p = 0.04, respectively). CONCLUSION Caregivers of TX patients appeared to have less burden, depression and anxiety levels compared with caregivers of patients on dialysis modalities. Caregivers' burden is significantly associated with anxiety, depressive symptoms, gender, duration of caregiving, educational level, financial status and caregivers' age.
Collapse
|
8
|
Fraser SDS, Stannard S, Holland E, Boniface M, Hoyle RB, Wilkinson R, Akbari A, Ashworth M, Berrington A, Chiovoloni R, Enright J, Francis NA, Giles G, Gulliford M, Macdonald S, Mair FS, Owen RK, Paranjothy S, Parsons H, Sanchez-Garcia RJ, Shiranirad M, Zlatev Z, Alwan N. Multidisciplinary ecosystem to study lifecourse determinants and prevention of early-onset burdensome multimorbidity (MELD-B) - protocol for a research collaboration. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2023; 13:26335565231204544. [PMID: 37766757 PMCID: PMC10521301 DOI: 10.1177/26335565231204544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023]
Abstract
Background Most people living with multiple long-term condition multimorbidity (MLTC-M) are under 65 (defined as 'early onset'). Earlier and greater accrual of long-term conditions (LTCs) may be influenced by the timing and nature of exposure to key risk factors, wider determinants or other LTCs at different life stages. We have established a research collaboration titled 'MELD-B' to understand how wider determinants, sentinel conditions (the first LTC in the lifecourse) and LTC accrual sequence affect risk of early-onset, burdensome MLTC-M, and to inform prevention interventions. Aim Our aim is to identify critical periods in the lifecourse for prevention of early-onset, burdensome MLTC-M, identified through the analysis of birth cohorts and electronic health records, including artificial intelligence (AI)-enhanced analyses. Design We will develop deeper understanding of 'burdensomeness' and 'complexity' through a qualitative evidence synthesis and a consensus study. Using safe data environments for analyses across large, representative routine healthcare datasets and birth cohorts, we will apply AI methods to identify early-onset, burdensome MLTC-M clusters and sentinel conditions, develop semi-supervised learning to match individuals across datasets, identify determinants of burdensome clusters, and model trajectories of LTC and burden accrual. We will characterise early-life (under 18 years) risk factors for early-onset, burdensome MLTC-M and sentinel conditions. Finally, using AI and causal inference modelling, we will model potential 'preventable moments', defined as time periods in the life course where there is an opportunity for intervention on risk factors and early determinants to prevent the development of MLTC-M. Patient and public involvement is integrated throughout.
Collapse
Affiliation(s)
- Simon DS Fraser
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, Southampton General Hospital, Southampton, UK
- NIHR Applied Research Collaboration Wessex, Southampton, UK
| | - Sebastian Stannard
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, Southampton General Hospital, Southampton, UK
| | - Emilia Holland
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, Southampton General Hospital, Southampton, UK
| | - Michael Boniface
- School of Electronics and Computer Science, University of Southampton, Southampton, UK
| | - Rebecca B Hoyle
- School of Mathematical Sciences, University of Southampton, Southampton, UK
| | | | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Swansea, UK
| | - Mark Ashworth
- School of Life Course and Population Sciences, King’s College London, London, UK
| | - Ann Berrington
- Department of Social Statistics and Demography, University of Southampton, Southampton, UK
| | - Roberta Chiovoloni
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Swansea, UK
| | | | - Nick A Francis
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, Southampton General Hospital, Southampton, UK
| | - Gareth Giles
- Public Policy Southampton, University of Southampton, Southampton, UK
| | - Martin Gulliford
- School of Life Course and Population Sciences, King’s College London, London, UK
| | - Sara Macdonald
- School of Health and Wellbeing, General Practice and Primary Care, University of Glasgow, Glasgow, UK
| | - Frances S Mair
- School of Health and Wellbeing, General Practice and Primary Care, University of Glasgow, Glasgow, UK
| | - Rhiannon K Owen
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Swansea, UK
| | - Shantini Paranjothy
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
- NHS Grampian Health Board, Aberdeen, UK
| | - Heather Parsons
- Patient and Public Involvement and Engagement, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ruben J Sanchez-Garcia
- School of Mathematical Sciences, University of Southampton, Southampton, UK
- The Alan Turing Institute, London, UK
| | - Mozhdeh Shiranirad
- School of Mathematical Sciences, University of Southampton, Southampton, UK
| | - Zlatko Zlatev
- School of Electronics and Computer Science, University of Southampton, Southampton, UK
| | - Nisreen Alwan
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, Southampton General Hospital, Southampton, UK
- Patient and Public Involvement and Engagement, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Southampton Biomedical Research Centre, Southampton, UK
- NIHR Applied Research Collaboration Wessex, Southampton, UK
| |
Collapse
|
9
|
van Pinxteren M, Mbokazi N, Murphy K, Mair FS, May C, Levitt NS. Using qualitative study designs to understand treatment burden and capacity for self-care among patients with HIV/NCD multimorbidity in South Africa: A methods paper. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2023; 13:26335565231168041. [PMID: 37057034 PMCID: PMC10088413 DOI: 10.1177/26335565231168041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
Background Low- and middle-income countries (LMICs), including South Africa, are currently experiencing multiple epidemics: HIV and the rising burden of non-communicable diseases (NCDs), leading to different patterns of multimorbidity (the occurrence of two or more chronic conditions) than experienced in high income settings. These adversely affect health outcomes, increase patients' perceived burden of treatment, and impact the workload of self-management. This paper outlines the methods used in a qualitative study exploring burden of treatment among people living with HIV/NCD multimorbidity in South Africa. Methods We undertook a comparative qualitative study to examine the interaction between individuals' treatment burden (self-management workload) and their capacity to take on this workload, using the dual lenses of Burden of Treatment Theory (BoTT) and Cumulative Complexity Model (CuCoM) to aid conceptualisation of the data. We interviewed 30 people with multimorbidity and 16 carers in rural Eastern Cape and urban Cape Town between February-April 2021. Data was analysed through framework analysis. Findings This paper discusses the methodological procedures considered when conducting qualitative research among people with multimorbidity in low-income settings in South Africa. We highlight the decisions made when developing the research design, recruiting participants, and selecting field-sites. We also explore data analysis processes and reflect on the positionality of the research project and researchers. Conclusion This paper illustrates the decision-making processes conducting this qualitative research and may be helpful in informing future research aiming to qualitatively investigate treatment burden among patients in LMICs.
Collapse
Affiliation(s)
- Myrna van Pinxteren
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, South Africa
| | - Nonzuzo Mbokazi
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, South Africa
| | - Katherine Murphy
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, South Africa
| | - Frances S Mair
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK; NIHR North Thames Applied Research Collaboration, London, UK
| | - Carl May
- School of Health and Well-Being, College of Medical, Veterinary and Life Sciences, University of Glasgow, Scotland, UK
| | - Naomi S Levitt
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, South Africa
| |
Collapse
|
10
|
Grosbois JM, Gephine S, Kyheng M, Le Rouzic O, Chenivesse C. Improving the wellbeing of caregivers of patients with COPD using a home-based pulmonary rehabilitation programme. ERJ Open Res 2022; 8:00255-2022. [PMID: 36655219 PMCID: PMC9835991 DOI: 10.1183/23120541.00255-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/11/2022] [Indexed: 01/21/2023] Open
Abstract
Objectives The aim of this study was to evaluate the effects of a home-based pulmonary rehabilitation (PR) programme on anxiety and depressive symptoms, general fatigue and burden in informal caregivers of patients with COPD. We also evaluated the baseline characteristics of both patients and caregivers that contributed to the change in caregiver's outcomes after PR. Methods In this retrospective study, patients with COPD were referred to an 8-week home-based PR programme consisting of a weekly supervised 90-min session. Informal caregivers were invited to participate in PR according to the patient's preference and its availability. Caregivers received educational support, behavioural therapies and self-management strategies using the same methods as for patients. Burden, anxiety and depressive symptoms, and general fatigue of caregivers were assessed at baseline and at the end of PR. Results 241 patients with COPD and 138 (57.3%) caregivers were included. The majority of the caregivers were women (70.5%) and spouses (90.3%) and had at least three comorbidities (57.3%). A large proportion of caregivers showed baseline high burden, anxiety symptoms and abnormal fatigue (40%, 40% and 45%, respectively). Burden, anxiety and depressive symptoms, and general fatigue of informal caregivers were all improved after PR (p<0.05). Long-term oxygen therapy and/or noninvasive ventilation, coronaropathy and/or peripheral arterial disease and a higher baseline modified Medical Research Council Dyspnoea scale score in patients with COPD were associated with a decrease in caregiver's burden after PR. Conclusion A large proportion of caregivers of patients with COPD showed anxiety symptoms, fatigue and a high burden. These outcomes were improved by integrating the caregiver into a home-based PR programme.
Collapse
Affiliation(s)
| | - Sarah Gephine
- Univ. Lille, Univ. Artois, Univ. Littoral Côte D'opale, ULR 7369-URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, France
| | - Maeva Kyheng
- CHU Lille, Department of Biostatistics, Univ. Lille, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, Lille, France
| | - Olivier Le Rouzic
- CHU Lille, Service de Pneumologie et Immuno-Allergologie, Centre de Référence Constitutif des Maladies Pulmonaires Rares, Lille, France,Univ. Lille, Lille, France
| | - Cécile Chenivesse
- CHU Lille, Service de Pneumologie et Immuno-Allergologie, Centre de Référence Constitutif des Maladies Pulmonaires Rares, Lille, France,Univ. Lille, Lille, France
| |
Collapse
|
11
|
Lippiett K, Richardson A, May CR. How do illness identity, patient workload and agentic capacity interact to shape patient and caregiver experience? Comparative analysis of lung cancer and chronic obstructive pulmonary disease. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4545-e4555. [PMID: 35633149 PMCID: PMC10084268 DOI: 10.1111/hsc.13858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 03/30/2022] [Accepted: 05/12/2022] [Indexed: 05/06/2023]
Abstract
Some patients have to work hard to manage their illness. When this work outweighs capacity (the resources available to patients to undertake the illness workload and other workloads such as that of daily life), this may result in treatment burden, associated with poor health outcomes for patients. This cross-sectional, comparative qualitative analysis uses an abductive approach to identify, characterise and explain treatment burden in chronic obstructive pulmonary disease (COPD) and lung cancer. It uses complementary qualitative methods (semi-structured interviews with patients receiving specialist care n = 19, specialist clinicians n = 5; non-participant observation of specialist outpatient consultations in two English hospitals [11 h, 52 min] n = 41). The findings underline the importance of the diagnostic process in relation to treatment burden; whether diagnosis is experienced as a biographically disruptive shock (as with lung cancer) or is insidiously biographically erosive (as with COPD).
Collapse
Affiliation(s)
- Kate Lippiett
- School of Health SciencesUniversity of SouthamptonSouthamptonUK
- NIHR Applied Research Collaboration WessexSouthamptonUK
| | - Alison Richardson
- School of Health SciencesUniversity of SouthamptonSouthamptonUK
- NIHR Applied Research Collaboration WessexSouthamptonUK
- University Hospital Southampton NHS Foundation TrustSouthamptonUK
| | - Carl R. May
- Faculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
- NIHR Applied Research Collaboration North ThamesLondonUK
| |
Collapse
|
12
|
Austin RC, Schoonhoven L, Koutra V, Richardson A, Kalra PR, May CR. SYMptoms in chronic heart failure imPACT on burden of treatment (SYMPACT): a cross-sectional survey. ESC Heart Fail 2022; 9:2279-2290. [PMID: 35451208 PMCID: PMC9288776 DOI: 10.1002/ehf2.13904] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/19/2022] [Accepted: 03/11/2022] [Indexed: 12/11/2022] Open
Abstract
Aims This study aimed to describe patient‐reported symptoms and burden of treatment (BoT) experienced by patients with chronic heart failure (CHF). BoT describes the illness workload, individual capacity to perform that work, and resultant impact on the individual. Overwhelming BoT is related to poor quality of life and worse clinical outcomes. This research is the first to explore symptoms and BoT in people with CHF, in the UK. Methods and results This is a cross‐sectional questionnaire survey of CHF patients. Participants completed the Heart Failure Symptom Survey (HFSS; max score 10) and the Minnesota Living with Heart Failure Questionnaire (MLHFQ; max scores: physical 40, emotional 25, and total 105), which measured symptoms. BoT was measured with the Patient Experience with Treatment and Self‐management (PETS; max score 100) questionnaires. Participant characteristics and questionnaire results were summarized using descriptive statistics. Relationships between symptoms and BoT, summarized by the workload and impact indices, were explored using Spearman's and Pearson's correlation coefficients together with scatter plots. The survey was completed by 333 participants, mean age of 71 (±13) years old. The majority (89%) were recruited from secondary care NHS trusts, and 25% were female. All types of heart failure were represented. Mean symptom scores were as follows: HFSS burden score: 2.4 (±2.1), and MLHFQ scores: physical score 20 (±12.4), emotional score 9.9 (±8.1), and total score 41.3 (±26.3). The highest mean PETS domain scores were exercise [51.3 (±24.7)], diet [40.3 (±22.7)], difficulty with healthcare services [39.9 (±21.3)], and physical and mental fatigue [36.0 (±25.7)]. Pairwise correlations were observed between HFSS scores and MLHFQ physical and emotional sub‐scores with PETS workload and impact indices. Positive correlations were weak to moderate (0.326–0.487) between workload index and symptoms, and moderate to strong between impact index and symptoms (0.553–0.725). The P value was 0.006, adjusted by Bonferroni's correction. Conclusions Symptoms are associated with BoT in CHF patients. Although symptom burden was low, CHF patients reported higher levels of burden around self‐care activities of exercise, diet, healthcare interaction, as well as physical and mental fatigue due to engagement with self‐care regimens. Observed higher levels of burden were in key self‐care areas for CHF and suggest areas where service delivery and support of CHF patients may be improved to reduce BoT. Clinicians could individualize their consultations by focusing on troublesome symptoms, as well as alleviating illness workload, which may better enable patients to live well with CHF.
Collapse
Affiliation(s)
- Rosalynn C Austin
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.,Department of Cardiology, Portsmouth Hospitals University NHS Trust (PHU), Queen Alexandra Hospital, Cardiology Research Nurses, C-Level, Southwick Hill, Cosham, Portsmouth, PO6 3LY, UK.,National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) Wessex, Southampton, UK
| | - Lisette Schoonhoven
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Vasiliki Koutra
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.,Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, Southampton, UK
| | - Alison Richardson
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.,National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) Wessex, Southampton, UK.,University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton, UK
| | - Paul R Kalra
- Department of Cardiology, Portsmouth Hospitals University NHS Trust (PHU), Queen Alexandra Hospital, Cardiology Research Nurses, C-Level, Southwick Hill, Cosham, Portsmouth, PO6 3LY, UK.,Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.,Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
| | - Carl R May
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.,Applied Research Collaboration (ARC) North Thames, National Institute for Health Research (NIHR), London, UK
| |
Collapse
|
13
|
Enoch J, Dickinson C, Potts J, Subramanian A. An exploratory study on support for caregivers of people with vision impairment in the UK. Ophthalmic Physiol Opt 2022; 42:858-871. [PMID: 35416314 PMCID: PMC9320821 DOI: 10.1111/opo.12989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 03/26/2022] [Accepted: 03/28/2022] [Indexed: 11/27/2022]
Abstract
Purpose Many of the UK's 2.5 million individuals living with vision loss receive support from relatives or friends (so‐called ‘informal caregivers’). However, there is limited understanding of how caregivers of people with visual impairment (PVI) are, or feel, supported by UK healthcare/statutory services and charities. This exploratory study was conducted to explore caregivers' experiences and their suggestions for enhancing support. Methods Participants self‐identifying as UK‐based caregivers of PVI (N = 100) volunteered to undertake an online survey, distributed through charity partners. The survey was comprised of the Client Satisfaction Questionnaire‐8 (CSQ‐8, a validated, self‐report measure of satisfaction with support services), Likert‐type questions and two open‐ended, free‐text questions. Interview participants (N = 22) were then selected from survey respondents, and semi‐structured interviews were conducted to focus on caregivers' ideas for improving support. The Framework Method was used for inductive analysis of the free‐text question responses and interview data. Results The mean (SD) CSQ‐8 score was 21.60 (7.2), with no significant differences by demographic, relationship or vision‐related factors, likely limited by the small subgroup sizes. Qualitative data demonstrated the heterogeneity of participating caregivers' experiences, highlighting the importance of personalised support for caregivers. Many participants advocated enhancing informational, practical, emotional and social support for caregivers, and stressed the importance of accessible services and consistent points of contact to turn to for support and advice. Conclusions Although our sample was arguably better connected to support services than the general caregiver population, this study identified concrete suggestions to improve practical, emotional and peer support for caregivers of PVI.
Collapse
Affiliation(s)
- Jamie Enoch
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | - Christine Dickinson
- Division of Pharmacy & Optometry, University of Manchester and the Manchester Academic Health Sciences Centre, Manchester, UK
| | | | - Ahalya Subramanian
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| |
Collapse
|
14
|
Bolton LE, Seymour J, Gardiner C. Existential suffering in the day to day lives of those living with palliative care needs arising from chronic obstructive pulmonary disease (COPD): A systematic integrative literature review. Palliat Med 2022; 36:567-580. [PMID: 35176924 PMCID: PMC9006392 DOI: 10.1177/02692163221074539] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND The impact of living with palliative care needs arising from COPD disrupts an individual's existential situation. However, no comprehensive synthesis of existing research has been published to determine the presentation and impact of existential suffering. AIM To provide a synthesis of existing evidence on existential suffering for those living with palliative care needs arising from COPD. DESIGN This is an integrative review paper, undertaken using the methodological approach developed by Soares and reported in accordance with PRISMA guidelines. Data analysis was undertaking using an integrated convergent synthesis approach. DATA SOURCES Nine electronic databases were searched from April 2019 to December 2019. A second search was undertaken in January 2021 to identify recently published papers meeting the inclusion and exclusion criteria. No date restrictions were imposed. Only papers published in the English Language were considered for inclusion. Empirical research papers employing qualitative and/or quantitative methodologies and systematic literature reviews were included. Articles were accepted for inclusion if they discussed any component of existential suffering when living with COPD and palliative care needs. RESULTS Thirty-five papers were included within this review comprising of seven systematic reviews, 10 quantitative studies and 18 qualitative studies. The following themes relating to existential suffering were found: Liminality, Lamented Life, Loss of Personal Liberty, Life meaning and Existential isolation. The absence of life meaning, and purpose was of most importance to participants. CONCLUSIONS This review suggests existential suffering is present and of significant impact within the daily lives of those living with palliative care needs arising from COPD. The absence of life meaning has the most significant impact. Further research is required to understand the essential components of an intervention to address existential suffering for this patient group, to ensure holistic palliative care delivery.
Collapse
Affiliation(s)
| | - Jane Seymour
- Division of Nursing & Midwifery, University of Sheffield, Sheffield, UK
| | - Clare Gardiner
- Division of Nursing & Midwifery, University of Sheffield, Sheffield, UK
| |
Collapse
|
15
|
Boehmer KR, Gallacher KI, Lippiett KA, Mair FS, May CR, Montori VM. Minimally Disruptive Medicine: Progress 10 Years Later. Mayo Clin Proc 2022; 97:210-220. [PMID: 35120690 DOI: 10.1016/j.mayocp.2021.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 09/03/2021] [Accepted: 09/13/2021] [Indexed: 12/17/2022]
Affiliation(s)
- Kasey R Boehmer
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA; Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA.
| | - Katie I Gallacher
- General Practice and Primary Care, University of Glasgow, Glasgow, UK
| | - Kate A Lippiett
- Macmillan Survivorship Research Group, University of Southampton, Southampton, UK
| | - Frances S Mair
- General Practice and Primary Care, University of Glasgow, Glasgow, UK
| | - Carl R May
- Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Victor M Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
16
|
Hardman R, Begg S, Spelten E. Exploring the ability of self-report measures to identify risk of high treatment burden in chronic disease patients: a cross-sectional study. BMC Public Health 2022; 22:163. [PMID: 35073896 PMCID: PMC8785389 DOI: 10.1186/s12889-022-12579-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 01/13/2022] [Indexed: 09/03/2023] Open
Abstract
Background Effective self-management of chronic health conditions is key to avoiding disease escalation and poor health outcomes, but self-management abilities vary. Adequate patient capacity, in terms of abilities and resources, is needed to effectively manage the treatment burden associated with chronic health conditions. The ability to measure different elements of capacity, as well as treatment burden, may assist to identify those at risk of poor self-management. Our aims were to: 1. Investigate correlations between established self-report tools measuring aspects of patient capacity, and treatment burden; and 2. Explore whether individual questions from the self-report tools will correlate to perceived treatment burden without loss of explanation. This may assist in the development of a clinical screening tool to identify people at risk of high treatment burden. Methods A cross-sectional survey in both a postal and online format. Patients reporting one or more chronic diseases completed validated self-report scales assessing social, financial, physical and emotional capacity; quality of life; and perceived treatment burden. Logistic regression analysis was used to explore relationships between different capacity variables, and perceived high treatment burden. Results Respondents (n = 183) were mostly female (78%) with a mean age of 60 years. Most participants were multimorbid (94%), with 45% reporting more than five conditions. 51% reported a high treatment burden. Following logistic regression analyses, high perceived treatment burden was correlated with younger age, material deprivation, low self-efficacy and usual activity limitation. These factors accounted for 50.7% of the variance in high perceived treatment burden. Neither disease burden nor specific diagnosis was correlated with treatment burden. Conclusions This study supports previous observations that psychosocial factors may be more influential than specific diagnoses for multimorbid patients in managing their treatment workload. A simple capacity measure may be useful to identify those who are likely to struggle with healthcare demands. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12579-1.
Collapse
|
17
|
Corbett T, Lee K, Cummings A, Calman L, Farrington N, Lewis L, Young A, Richardson A, Foster C, Bridges J. Self-management by older people living with cancer and multi-morbidity: a qualitative study. Support Care Cancer 2022; 30:4823-4833. [PMID: 35147757 PMCID: PMC8831683 DOI: 10.1007/s00520-022-06892-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 01/31/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Over half of individuals diagnosed with cancer are aged over 70 years, and more than 75% of those with cancer report at least one other medical condition. Having multiple conditions alongside cancer in old age may lower functional status, greater likelihood of treatment complications and less favourable prognoses. This qualitative study explored how older people with long-term chronic conditions manage their health and meet their health-related goals after they have completed treatment for cancer. METHODS One-to-one face-to-face qualitative interviews were conducted with 8 older people and 2 informal caregivers based in the UK. Older adults were eligible to participate if they were over 70 and had completed primary cancer treatment with curative intent and had at least one other chronic health condition. A semi-structured interview schedule developed a priori based on Shippee's cumulative complexity model was used. We aimed to explore experiences that could influence self-management, utilisation of healthcare services and health outcomes. A framework analysis was used to describe and interpret the data. RESULTS Four overarching themes were identified in the analysis. These themes related to factors that influenced the everyday health-related workload and capacity of the participants. These factors included their health, resources, and opportunities, as well their motivation and sense of perceived control over their lives. CONCLUSIONS Fragmented healthcare systems and relationships with healthcare professionals also influenced the participants' self-management of their health. Our findings highlight the interaction between an individuals' needs, capacity, treatment burden, and the services and resources available to them. These findings support calls to promote person-centred care to better support older adults to manage their health.
Collapse
Affiliation(s)
- Teresa Corbett
- Faculty of Sport, Health, and Social Sciences, Solent University, Southampton, SO14 0YN UK
| | - Kellyn Lee
- NIHR ARC Wessex, School of Health Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ UK
| | - Amanda Cummings
- Macmillan Survivorship Research Group, School of Health Sciences, University of Southampton, Southampton, SO17 1BJ UK
| | - Lynn Calman
- Macmillan Survivorship Research Group, School of Health Sciences, University of Southampton, Southampton, SO17 1BJ UK
| | - Naomi Farrington
- University Hospital Southampton & University of Southampton, Tremona Road, Southampton, SO16 6YD UK
| | - Lucy Lewis
- Southern Health NHS Foundation Trust, Southampton, UK
| | - Alexandra Young
- NIHR ARC Wessex, School of Health Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ UK
| | - Alison Richardson
- NIHR ARC Wessex, School of Health Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ UK
| | - Claire Foster
- Macmillan Survivorship Research Group, School of Health Sciences, University of Southampton, Southampton, SO17 1BJ UK
| | - Jackie Bridges
- NIHR ARC Wessex, School of Health Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ UK
| |
Collapse
|
18
|
Roberti J, Alonso JP, Blas L, May C. How do social and economic vulnerabilities shape the work of participating in care? Everyday experiences of people living with kidney failure in Argentina. Soc Sci Med 2021; 293:114666. [PMID: 34952327 DOI: 10.1016/j.socscimed.2021.114666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 12/08/2021] [Accepted: 12/17/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND A new chronic patient has emerged, with a burden of symptoms and treatment. Patients with kidney failure (KF) require complex and expensive treatments, and in underresourced contexts, they struggle to obtain quality and timely care, even in countries with universal health coverage. We describe how, in such a setting, social structural factors and control over services placed by the system affect the burden of treatment of patients. METHOD This qualitative study was undertaken in Buenos Aires, Argentina. Semistructured interviews were conducted with patients with KF (n = 50) and health professionals (n = 14) caring for these patients. Additionally, three types of health coverage were included: public health, social security and private healthcare, with diverse socioeconomic backgrounds. FINDINGS Patients' agency to meet demands is extended by relational networks with redistributed responsibilities and roles. Networks provided logistical, financial, emotional support; indeed, patients with limited networks were susceptible to rapid health deterioration, as treatment interruptions could not be identified in time. Control over services translated into scarce information about treatment options, changing dialysis schedules, lack of contact with transplant teams, and new rules to access medication or make requests. For any type of coverage, there was an economic burden related to noncovered medication, copayments, travel, caregivers, specialized diets, and moving to a city offering treatment. Many patients reported economic difficulties that prevented them from even affording meals. Hardships worsened by unemployment because of the disease. Some patients had migrated seeking treatment, leaving everything behind, but could not return without risking their life. Transplanted patients often needed to re-enter the labor market against a background of high unemployment rates. CONCLUSION While health policy and practices encourage self-management, the patient may not have the capacity to meet the system's demands. A better understanding of BoT could contribute to improving how patients experience their illness.
Collapse
Affiliation(s)
- Javier Roberti
- Qualitative Research in Health, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina; CIESP / National Scientific and Technical Research Council (CONICET), Argentina.
| | - Juan Pedro Alonso
- Qualitative Research in Health, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina; Gino Germani Research Institute, Buenos Aires, Argentina
| | - Leandro Blas
- Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Carl May
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
19
|
Niño de Guzmán E, Martínez García L, González AI, Heijmans M, Huaringa J, Immonen K, Ninov L, Orrego-Villagrán C, Pérez-Bracchiglione J, Salas-Gama K, Viteri-García A, Alonso-Coello P. The perspectives of patients and their caregivers on self-management interventions for chronic conditions: a protocol for a mixed-methods overview. F1000Res 2021; 9:120. [PMID: 35186277 PMCID: PMC8825946 DOI: 10.12688/f1000research.22125.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction: Self-management (SM) interventions are complex interventions and one of the main components of high-quality chronic disease care for which the incorporation of the perspectives of patients and their informal caregivers is crucial. We aim to identify, appraise and synthesise the evidence exploring patients’ and caregivers’ perspectives on SM interventions. More precisely, we aim to 1) describe how they value the importance of outcomes of SM interventions, and 2) identify the factors that might impact on acceptability and feasibility of SM interventions based on their preferences and experiences. Methods and analysis: We will conduct four mixed-methods overviews as part of COMPAR-EU, a European Union (EU) funded project aimed to identify the most effective and cost-effective SM interventions for chronic obstructive pulmonary disease (COPD), heart failure (HF), obesity, and type 2 diabetes mellitus (T2DM). We will search in MEDLINE, CINAHL, and PsycINFO for systematic reviews of studies addressing patients’ preferences on outcomes, or their experiences with SM alongside their disease trajectory or with SM interventions, published in English. Selection of studies and data extraction will be conducted in pairs. We will assess the overlap of studies and methodological quality. We will follow a three-step synthesis process: 1) narrative synthesis for quantitative evidence, 2) thematic synthesis for qualitative evidence, and 3) integration of findings in the interpretation phase. Additionally, we will consult on the relevance of findings with patients and their caregivers. Systematic review registration: PROSPERO CRD42019117867
Collapse
Affiliation(s)
- Ena Niño de Guzmán
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, 08025, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laura Martínez García
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, 08025, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Ana I. González
- Avedis Donabedian Research Institute (FAD), Barcelona, 08037, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
| | - Monique Heijmans
- Netherlands institute for health services research (Nivel), Utrecht, 3513, The Netherlands
| | | | | | | | - Carola Orrego-Villagrán
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Avedis Donabedian Research Institute (FAD), Barcelona, 08037, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
| | - Javier Pérez-Bracchiglione
- Interdisciplinary Centre for Health Studies (CIESAL), Universidad de Valparaíso, Valparaíso, 2520000, Chile
| | | | - Andrés Viteri-García
- Universidad UTE, Quito, 170527, Ecuador
- Cochrane Ecuador, Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC), Quito, 170527, Ecuador
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, 08025, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| |
Collapse
|
20
|
Seljelid B, Varsi C, Solberg Nes L, Øystese KA, Børøsund E. Feasibility of a Digital Patient–Provider Communication Intervention to Support Shared Decision Making in Chronic Health Care, InvolveMe: A Pilot Study (Preprint). JMIR Form Res 2021; 6:e34738. [PMID: 35389356 PMCID: PMC9030980 DOI: 10.2196/34738] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/21/2022] [Accepted: 03/14/2022] [Indexed: 01/19/2023] Open
Abstract
Background Enhanced communication with health care providers (HCPs) can improve symptom management and health-related quality of life (HRQoL) for patients with chronic health conditions. Access to appropriate communication venues is needed to improve communication, however. As such, digital communication interventions mediated by patient portals carry the potential to support patient-provider communication and interaction and through this, also facilitate shared decision-making (SDM). The InvolveMe intervention was designed to provide patients with the opportunity to communicate symptoms and informational needs prior to consultation via digital assessment, including prioritizing what is most important to discuss with their HCPs, as well as to interact with HCPs through secure messages between outpatient visits. Objective The aim of this study was to assess the feasibility of the InvolveMe intervention by investigating acceptability, demand (ie, system use), and limited efficacy. Methods The study was designed as a single-arm, pre-post feasibility study combining quantitative and qualitative methods for data collection. Patients from an endocrine outpatient clinic were invited to use the InvolveMe intervention for 3 months, and HCPs administering InvolveMe were invited to participate in a focus group. Guided by descriptions of how to design feasibility studies by Bowen et al, feasibility was tested by exploring (1) acceptability, using data collected during recruitment from patient participants and nonparticipants (ie, declined to participate or did not meet study requirements), HCP experiences with recruitment, and the System Usability Scale (SUS); (2) demand via exploration of system use through extraction of system log data and HCP experiences with system use; and (3) limited efficacy testing, via exploration of potential effects from the Short-Form Health Survey (RAND 36), Hospital Anxiety and Depression Scale, and Health Literacy Questionnaire. Results Patient participants (N=23) were a median 54 (range 26-78) years old and primarily male (14/23, 61%). Nonparticipants (N=16) were a median 73 (range 55-80) years old and primarily male (12/16, 75%). The average SUS score was 72.2, indicating good system usability. Assessments were completed by 8 participants from home prior to outpatient visits. The assessments entailed various bodily symptoms and needs for information. Participants sent 17 secure messages related to patient administrative matters, symptoms, and challenges. Focus group participants (N=4) were all female and registered nurses. Data were analyzed in 2 predefined themes: Acceptability and Demand. Acceptability included the subthemes intervention attractiveness and intervention suitability. Demand included the subthemes elements of SDM and intervention challenges and opportunities. All patient participants completed outcome measures at baseline, and 19 (19/23, 83%) completed outcome measures at 3 months. These preliminary efficacy findings were mixed and inconclusive. Conclusions The study design provided findings from both patient and HCP perspectives and supported feasibility of the InvolveMe intervention. The investigation of acceptability and demand supported the potential for remote SDM mediated by patient portals using assessments and secure messages. Trial Registration ClinicalTrials.gov NCT NCT04218721; https://www.clinicaltrials.gov/ct2/show/NCT04218721
Collapse
Affiliation(s)
- Berit Seljelid
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Cooperation, Patient Education and Equivalent Health Services, Oslo University Hospital, Oslo, Norway
| | - Cecilie Varsi
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Lise Solberg Nes
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatry & Psychology, College of Medicine & Science, Mayo Clinic, Rochester, MN, United States
| | - Kristin Astrid Øystese
- Section of Specialized Endocrinology, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Department of Medical Biochemistry, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Elin Børøsund
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
21
|
Niño de Guzmán Quispe E, Martínez García L, Orrego Villagrán C, Heijmans M, Sunol R, Fraile-Navarro D, Pérez-Bracchiglione J, Ninov L, Salas-Gama K, Viteri García A, Alonso-Coello P. The Perspectives of Patients with Chronic Diseases and Their Caregivers on Self-Management Interventions: A Scoping Review of Reviews. THE PATIENT 2021; 14:719-740. [PMID: 33871808 PMCID: PMC8563562 DOI: 10.1007/s40271-021-00514-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/26/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND Self-management (SM) interventions are supportive interventions systematically provided by healthcare professionals, peers, or laypersons to increase the skills and confidence of patients in their ability to manage chronic diseases. We had two objectives: (1) to summarise the preferences and experiences of patients and their caregivers (informal caregivers and healthcare professionals) with SM in four chronic diseases and (2) to identify and describe the relevant outcomes for SM interventions from these perspectives. METHODS We conducted a mixed-methods scoping review of reviews. We searched three databases until December 2020 for quantitative, qualitative, or mixed-methods reviews exploring patients' and caregivers' preferences or experiences with SM in type 2 diabetes mellitus (T2DM), obesity, chronic obstructive pulmonary disease (COPD), and heart failure (HF). Quantitative data were narratively synthesised, and qualitative data followed a three-step descriptive thematic synthesis. Identified themes were categorised into outcomes or modifiable factors of SM interventions. RESULTS We included 148 reviews covering T2DM (n = 53 [35.8%]), obesity (n = 20 [13.5%]), COPD (n = 32 [21.6%]), HF (n = 38 [25.7%]), and those with more than one disease (n = 5 [3.4%]). We identified 12 main themes. Eight described the process of SM (disease progression, SM behaviours, social support, interaction with healthcare professionals, access to healthcare, costs for patients, culturally defined roles and perceptions, and health knowledge), and four described their experiences with SM interventions (the perceived benefit of the intervention, individualised care, sense of community with peers, and usability of equipment). Most themes and subthemes were categorised as outcomes of SM interventions. CONCLUSION The process of SM shaped the perspectives of patients and their caregivers on SM interventions. Their perspectives were influenced by the perceived benefit of the intervention, the sense of community with peers, the intervention's usability, and the level of individualised care. Our findings can inform the selection of patient-important outcomes, decision-making processes, including the formulation of recommendations, and the design and implementation of SM interventions.
Collapse
Affiliation(s)
- Ena Niño de Guzmán Quispe
- Iberoamerican Cochrane Centre (IbCC)-Sant Pau Biomedical Research Institute (IIB-Sant Pau), C/ Sant Antoni Maria Claret 167. Pabellón 18, Planta 0, 08025, Barcelona, Spain.
| | - Laura Martínez García
- Iberoamerican Cochrane Centre (IbCC)-Sant Pau Biomedical Research Institute (IIB-Sant Pau), C/ Sant Antoni Maria Claret 167. Pabellón 18, Planta 0, 08025, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Carola Orrego Villagrán
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Monique Heijmans
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
| | - Rosa Sunol
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - David Fraile-Navarro
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Madrid Primary Health Care Service, Madrid, Spain
| | | | | | - Karla Salas-Gama
- Health Services Research Group, Institut de Recerca Vall d'Hebron Hospital, Barcelona, Spain
- Vall d'Hebron University Hospital, Barcelona, Spain
| | - Andrés Viteri García
- Centro de Investigación de Salud Pública y Epidemiología Clínica (CISPEC), Universidad UTE, Quito, Ecuador
- Centro Asociado Cochrane de Ecuador, Universidad UTE, Quito, Ecuador
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre (IbCC)-Sant Pau Biomedical Research Institute (IIB-Sant Pau), C/ Sant Antoni Maria Claret 167. Pabellón 18, Planta 0, 08025, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| |
Collapse
|
22
|
Rossi Ferrario S, Panzeri A, Pistono M. Psychological difficulties of LVAD patients and caregivers: A follow up over 1 year from discharge. Artif Organs 2021; 46:479-490. [PMID: 34519060 PMCID: PMC9292387 DOI: 10.1111/aor.14071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/24/2021] [Accepted: 08/31/2021] [Indexed: 12/13/2022]
Abstract
Background After the rehabilitation program, patients with left ventricular assist device (LVAD) are discharged home, but the adaption to the daily life with the implant is challenging, both with practical and psychological consequences. Literature is lacking detailed information about the quality of life of LVAD patients and caregivers after discharge to home. Objective This study aimed at evaluating the post‐discharge outcomes of both LVAD patients and their caregivers in terms of quality of life, affectivity, and psychological health. Methods In this observational follow‐up study, LVAD dyads discharged home from 1 year to 6 years were re‐contacted by phone and received by mail an envelope with self‐report questionnaires. Responses of 39 complete dyads of patients (mean age 68.59 ± 4.31; males: 92.31%) and their caregivers (mean age 61.59 ± 11.64; males: 17.95%) were analyzed. Results Patients and caregivers reported the moderate levels of anxiety, depression, and caregiver strain, and Illness denial and conscious avoidance were associated between them. The couples often reported that the LVAD has impairments for their sleep and for their affective–sexual relationship. Caregivers often reported impairment in social life and self‐care. Discussions Despite the satisfaction for the medical and territorial assistance, patients showed psychological difficulties such as anxious and depressive symptoms and caregivers tend to neglect themselves. Even after a long time from discharge to home, the psychological distress of LVAD patients and caregivers is still considerable. Structured and continuous psychological interventions are required to support their psychological health overtime after the discharge to home.
Collapse
Affiliation(s)
- Silvia Rossi Ferrario
- Unit of Psychology-Neuropsychology, IRCCS ICS Maugeri, Institute of Veruno, Veruno, Italy
| | - Anna Panzeri
- Department of General Psychology, University of Padua, Padova, Italy
| | - Massimo Pistono
- Unit of Cardiology, IRCCS ICS Maugeri, Institute of Veruno, Veruno, Italy
| |
Collapse
|
23
|
Montori VM. Removing the blindfold: The centrality of care in caring for patients with multiple chronic conditions. Health Serv Res 2021; 56 Suppl 1:969-972. [PMID: 34378207 DOI: 10.1111/1475-6773.13865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 07/28/2021] [Accepted: 08/01/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- Victor M Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
24
|
Pollock K, Wilson E, Caswell G, Latif A, Caswell A, Avery A, Anderson C, Crosby V, Faull C. Family and health-care professionals managing medicines for patients with serious and terminal illness at home: a qualitative study. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
More effective ways of managing symptoms of chronic and terminal illness enable patients to be cared for, and to die, at home. This requires patients and family caregivers to manage complex medicines regimens, including powerful painkillers that can have serious side effects. Little is known about how patients and family caregivers manage the physical and emotional work of managing medicines in the home or the support that they receive from health-care professionals and services.
Objective
To investigate how patients with serious and terminal illness, their family caregivers and the health-care professionals manage complex medication regimens and routines of care in the domestic setting.
Design
A qualitative study involving (1) semistructured interviews and group discussions with 40 health-care professionals and 21 bereaved family caregivers, (2) 20 patient case studies with up to 4 months’ follow-up and (3) two end-of-project stakeholder workshops.
Setting
This took place in Nottinghamshire and Leicestershire, UK.
Results
As patients’ health deteriorated, family caregivers assumed the role of a care co-ordinator, undertaking the everyday work of organising and collecting prescriptions and storing and administering medicines around other care tasks and daily routines. Participants described the difficulties of navigating a complex and fragmented system and the need to remain vigilant about medicines prescribed, especially when changes were made by different professionals. Access to support, resilience and coping capacity are mediated through the resources available to patients, through the relationships that they have with people in their personal and professional networks, and, beyond that, through the wider connections – or disconnections – that these links have with others. Health-care professionals often lacked understanding of the practical and emotional challenges involved. All participants experienced difficulties in communication and organisation within a health-care system that they felt was complicated and poorly co-ordinated. Having a key health professional to support and guide patients and family caregivers through the system was important to a good experience of care.
Limitations
The study achieved diversity in the recruitment of patients, with different characteristics relating to the type of illness and socioeconomic circumstances. However, recruitment of participants from ethnically diverse and disadvantaged or hard-to-reach populations was particularly challenging, and we were unable to include as many participants from these groups as had been originally planned.
Conclusions
The study identified two key and inter-related areas in which patient and family caregiver experience of managing medicines at home in end-of-life care could be improved: (1) reducing work and responsibility for medicines management and (2) improving co-ordination and communication in health care. It is important to be mindful of the need for transparency and open discussion about the extent to which patients and family caregivers can and should be co-opted as proto-professionals in the technically and emotionally demanding tasks of managing medicines at the end of life.
Future work
Priorities for future research include investigating how allocated key professionals could integrate and co-ordinate care and optimise medicines management; the role of domiciliary home care workers in supporting medicines management in end-of-life care; patient and family perspectives and understanding of anticipatory prescribing and their preferences for involvement in decision-making; the experience of medicines management in terminal illness among minority, disadvantaged and hard-to-reach patient groups; and barriers to and facilitators of increased involvement of community pharmacists in palliative and end-of-life care.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 14. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Kristian Pollock
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Eleanor Wilson
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Glenys Caswell
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Asam Latif
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Alan Caswell
- Patient and Public Involvement Representative, Dementia, Frail Older and Palliative Care Patient and Public Involvement Advisory Group, University of Nottingham, Nottingham, UK
| | - Anthony Avery
- School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Claire Anderson
- School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Vincent Crosby
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | |
Collapse
|
25
|
Austin RC, Schoonhoven L, Clancy M, Richardson A, Kalra PR, May CR. Do chronic heart failure symptoms interact with burden of treatment? Qualitative literature systematic review. BMJ Open 2021; 11:e047060. [PMID: 34330858 PMCID: PMC8327846 DOI: 10.1136/bmjopen-2020-047060] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Explore the interaction between patient experienced symptoms and burden of treatment (BoT) theory in chronic heart failure (CHF). BoT explains how dynamic patient workload (self-care) and their capacity (elements influencing capability), impacts on patients' experience of illness. DESIGN Review of qualitative research studies. DATA SOURCES CINAHL, EMBASE, MEDLINE, PsycINFO, Scopus and Web of Science were searched between January 2007 and 2020. ELIGIBILITY CRITERIA Journal articles in English, reporting qualitative studies on lived experience of CHF. RESULTS 35 articles identified related to the lived experience of 720 patients with CHF. Symptoms with physical and emotional characteristics were identified with breathlessness, weakness, despair and anxiety most prevalent. Identifying symptoms' interaction with BoT framework identified three themes: (1) Symptoms appear to infrequently drive patients to engage in self-care (9.2% of codes), (2) symptoms appear to impede (70.5% of codes) and (3) symptoms form barriers to self-care engagement (20.3% of codes). Symptoms increase illness workload, making completing tasks more difficult; simultaneously, symptoms alter a patient's capacity, through a reduction in their individual capabilities and willingness to access external resources (ie, hospitals) often with devasting impact on patients' lives. CONCLUSIONS Symptoms appear to be integral in the patient experience of CHF and BoT, predominately acting to impede patients' efforts to engage in self-care. Symptoms alter illness workload, increasing complexity and hardship. Patients' capacity is reduced by symptoms, in what they can do and their willingness to ask for help. Symptoms can lower their perceived self-value and roles within society. Symptoms appear to erode a patient's agency, decreasing self-value and generalised physical deconditioning leading to affective paralysis towards self-care regimens. Together describing a state of overwhelming BoT which is thought to be a contributor to poor engagement in self-care and may provide new insights into the perceived poor adherence to self-care in the CHF population. PROSPERO REGISTRATION NUMBER CRD42017077487.
Collapse
Affiliation(s)
- Rosalynn C Austin
- Department of Cardiology, Portsmouth Hospitals University NHS Trust, Portsmouth, Hampshire, UK
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, Hampshire, UK
- National Institite for Health Research (NIHR) Applied Research Collaboration (ARC) Wessex, Southampton, UK
| | - Lisette Schoonhoven
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, Hampshire, UK
- National Institite for Health Research (NIHR) Applied Research Collaboration (ARC) Wessex, Southampton, UK
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Mike Clancy
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, Hampshire, UK
- University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton, UK
| | - Alison Richardson
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, Hampshire, UK
- National Institite for Health Research (NIHR) Applied Research Collaboration (ARC) Wessex, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton, UK
| | - Paul R Kalra
- Department of Cardiology, Portsmouth Hospitals University NHS Trust, Portsmouth, Hampshire, UK
- Faculty of Health and Science, University of Portsmouth, Portsmouth, Hampshire, UK
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland
| | - Carl R May
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- National Institute for Health Research (NIHR), Applied Research Collaboration (ARC) North Thames, London, UK
| |
Collapse
|
26
|
Seljelid B, Varsi C, Solberg Nes L, Øystese KA, Børøsund E. A Digital Patient-Provider Communication Intervention (InvolveMe): Qualitative Study on the Implementation Preparation Based on Identified Facilitators and Barriers. J Med Internet Res 2021; 23:e22399. [PMID: 33830063 PMCID: PMC8294341 DOI: 10.2196/22399] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/09/2020] [Accepted: 03/18/2021] [Indexed: 01/15/2023] Open
Abstract
Background Chronic health conditions are affecting an increasing number of individuals, who experience various symptoms that decrease their quality of life. Digital communication interventions that enable patients to report their symptoms have been shown to positively impact chronic disease management by improving access to care, patient-provider communication, clinical outcomes, and health-related quality of life. These interventions have the potential to prepare patients and health care providers (HCPs) before visits and improve patient-provider communication. Despite the recent rapid development and increasing number of digital communication interventions that have shown positive research results, barriers to realizing the benefits offered through these types of interventions still exist. Objective The aim of this study is to prepare for the implementation of a digital patient-provider communication intervention in the daily workflow at 2 outpatient clinics by identifying potential determinants of implementation using the Consolidated Framework for Implementation Research (CFIR) to tailor the use of digital communication intervention to the intended context and identify key aspects for an implementation plan. Methods A combination of focus groups, workshops, and project steering committee meetings was conducted with HCPs (n=14) and patients (n=2) from 2 outpatient clinics at a university hospital. The CFIR was used to guide data collection and analysis. Transcripts, written minutes, and notes were analyzed and coded into 5 CFIR domains using thematic analysis. Results Data were examined and analyzed into 18 CFIR constructs relevant to the study purpose. On the basis of the identified determinants, important intervention tailoring includes adjustments to the digital features and adjustments to fit the clinical workflow and a decision to conduct a future pilot study. Furthermore, it was decided to provide the intervention to patients as early as possible in their disease trajectory, with tailored information about its use. Key aspects for the implementation plan encompassed maintaining the identified engagement and positive attitude, involving key stakeholders in the implementation process, and providing the needed support and training. Conclusions This study offers insight into the involvement of stakeholders in the tailoring and implementation planning of a digital communication intervention in clinical practice. Stakeholder involvement in the identification of implementation facilitators and barriers can contribute to the tailoring of digital communication interventions and how they are used and can also inform systematic and targeted implementation planning.
Collapse
Affiliation(s)
- Berit Seljelid
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Cooperation, Patient Education and Equivalent Health Services, CEO's Staff, Oslo University Hospital, Oslo, Norway
| | - Cecilie Varsi
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.,Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Lise Solberg Nes
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatry & Psychology, College of Medicine & Science, Mayo Clinic, Rochester, MN, United States
| | - Kristin Astrid Øystese
- Section of Specialized Endocrinology, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway.,Department of Medical Biochemistry, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Elin Børøsund
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
27
|
Sedlar N, Lainscak M, Farkas J. Self-care perception and behaviour in patients with heart failure: A qualitative and quantitative study. ESC Heart Fail 2021; 8:2079-2088. [PMID: 33719209 PMCID: PMC8120357 DOI: 10.1002/ehf2.13287] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/14/2021] [Accepted: 02/23/2021] [Indexed: 12/22/2022] Open
Abstract
Background and objective Self‐care strategies in heart failure (HF) are effective for disease management, yet adherence in many patients is inadequate. Reasons are presumably multifactorial but remain insufficiently investigated; thus, we aimed to analyse self‐care adherence and associated factors in outpatients with HF. Methods and results To measure self‐care levels and explore barriers and facilitators to self‐care adherence in patients with HF, quantitative study using the European Self‐Care Behaviour Scale (EHFScBS‐9) (n = 80; NYHA II–III, mean age 72 ± 10 years, 58% male) and qualitative study using semi‐structured interviews (n = 32; NYHA II–III, mean age 73 ± 11, 63% male) were conducted. We detected lowest adherence to regular exercise (39%) and contacts with healthcare provider in case of worsening symptoms (47%), whereas adherence was highest for regular medication taking (94%). Using the EHFScBS‐9 standardized cut‐off score ≤ 70, 51% of patients reported inadequate self‐care. Binary logistic regression analysis showed significant influence of education (OR = 0.314, 95% CI: 0.103–0.959) and perceived control (OR = 1.236, 95% CI: 1.043–1.465) on self‐care adequacy. According to the situation‐specific theory of HF self‐care, most commonly reported factors affecting the process of self‐care were knowledge about HF self‐care behaviours (84%), experience with healthcare professionals (84%), beliefs about their expertise (69%) and habits related to medication taking (72%). Among values, working responsibilities (53%) and maintenance of traditions (31%) appeared as the most prevalent socially based values affecting motivation for self‐care. Situational characteristics related to the person (self‐confidence, 53%; adaptive coping strategies, 88%), problem (burdensome breathing difficulties, 56%; co‐morbidities, 81%) and environment (practical support from family/caregivers, 59%; financial difficulties, 50%) were also commonly reported. Conclusions Various factors, including health‐related beliefs, habits and socially based values, need to be taken into account when planning self‐care interventions in patients with HF. A patient tailored approach should be based on adequate patient evaluation, taking into consideration the particular personal and social context.
Collapse
Affiliation(s)
- Natasa Sedlar
- National Institute of Public Health, Ljubljana, Slovenia
| | - Mitja Lainscak
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Division of Cardiology, General Hospital Murska Sobota, Murska Sobota, Slovenia
| | - Jerneja Farkas
- National Institute of Public Health, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Department of Research, General Hospital Murska Sobota, Murska Sobota, Slovenia
| |
Collapse
|
28
|
Ambrosio L, Hislop‐Lennie K, Barker H, Culliford D, Portillo MC. Living with Long term condition Scale: A pilot validation study of a new person centred tool in the UK. Nurs Open 2021; 8:1909-1919. [PMID: 33723922 PMCID: PMC8186700 DOI: 10.1002/nop2.859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 02/07/2021] [Accepted: 03/01/2021] [Indexed: 11/07/2022] Open
Abstract
AIM To cross-culturally adapt and determine the preliminary psychometric properties of the English version of the LwLTC Scale in people living with long-term conditions in the UK. DESIGN Cross-cultural adaptation and cross-sectional study. METHODS Forty-nine patients with five long-term conditions were included in the pilot study. Patients completed the English version of the LwLTC Scale and a bespoke questionnaire related to the scale. Feasibility/acceptability, internal consistency and construct validity were analysed. RESULTS 59.2% of participants were female, with an average age of 65.9 (SD = 12.30). Cronbach's alpha coefficient ranged between 0.50 and 0.84. Content validity showed that the English version of the LwLTC Scale was useful even negative items were identified. CONCLUSION These preliminary psychometric properties are satisfactory and promising. Further psychometric analyses are needed to verify them in a larger and more representative sample size during the main validation study, which is now in process.
Collapse
Affiliation(s)
- Leire Ambrosio
- School of Health SciencesUniversity of SouthamptonHampshireUK
- NIHR Applied Research CollaborationWessex University of SouthamptonHampshireUK
| | | | - Hannah Barker
- NIHR Applied Research CollaborationWessex University of SouthamptonHampshireUK
| | - David Culliford
- School of Health SciencesUniversity of SouthamptonHampshireUK
- NIHR Applied Research CollaborationWessex University of SouthamptonHampshireUK
| | - Mari Carmen Portillo
- School of Health SciencesUniversity of SouthamptonHampshireUK
- NIHR Applied Research CollaborationWessex University of SouthamptonHampshireUK
| |
Collapse
|
29
|
Hardman R, Begg S, Spelten E. Healthcare professionals' perspective on treatment burden and patient capacity in low-income rural populations: challenges and opportunities. BMC FAMILY PRACTICE 2021; 22:50. [PMID: 33750306 PMCID: PMC7942213 DOI: 10.1186/s12875-021-01387-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/13/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND The challenges of chronic disease self-management in multimorbidity are well-known. Shippee's Cumulative Complexity Model provides useful insights on burden and capacity factors affecting healthcare engagement and outcomes. This model reflects patient experience, but healthcare providers are reported to have a limited understanding of these concepts. Understanding burden and capacity is important for clinicians, since they can influence these factors both positively and negatively. This study aimed to explore the perspectives of healthcare providers using burden and capacity frameworks previously used only in patient studies. METHODS Participants were twelve nursing and allied health providers providing chronic disease self-management support in low-income primary care settings. We used written vignettes, constructed from interviews with multimorbid patients at the same health centres, to explore how clinicians understood burden and capacity. Interviews were recorded and transcribed verbatim. Analysis was by the framework method, using Normalisation Process Theory to explore burden and the Theory of Patient Capacity to explore capacity. RESULTS The framework analysis categories fitted the data well. All participants clearly understood capacity and were highly conscious of social (e.g. income, family demands), and psychological (e.g. cognitive, mental health) factors, in influencing engagement with healthcare. Not all clinicians recognised the term 'treatment burden', but the concept that it represented was familiar, with participants relating it both to specific treatment demands and to healthcare system deficiencies. Financial resources, health literacy and mental health were considered to have the biggest impact on capacity. Interaction between these factors and health system barriers (leading to increased burden) was a common and challenging occurrence that clinicians struggled to deal with. CONCLUSIONS The ability of health professionals to recognise burden and capacity has been questioned, but participants in this study displayed a level of understanding comparable to the patient literature. Many of the challenges identified were related to health system issues, which participants felt powerless to address. Despite their awareness of burden and capacity, health providers continued to operate within a single-disease model, likely to increase burden. These findings have implications for health system organisation, particularly the need for alternative models of care in multimorbidity.
Collapse
Affiliation(s)
- Ruth Hardman
- La Trobe University Rural Health School, 471 Benetook Avenue, Mildura, VIC, 3500, Australia. .,Sunraysia Community Health Services, 137 Thirteenth Street, Mildura, VIC, 3500, Australia.
| | - Stephen Begg
- La Trobe Rural Health School, La Trobe University, PO Box 199, Bendigo, VIC, 3552, Australia
| | - Evelien Spelten
- La Trobe University Rural Health School, 471 Benetook Avenue, Mildura, VIC, 3500, Australia
| |
Collapse
|
30
|
Nordfonn OK, Morken IM, Bru LE, Larsen AI, Husebø AML. Burden of treatment in patients with chronic heart failure - A cross-sectional study. Heart Lung 2021; 50:369-374. [PMID: 33618147 DOI: 10.1016/j.hrtlng.2021.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 01/27/2021] [Accepted: 02/01/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Patients with heart failure (HF) must manage both a demanding treatment regimen and self-care, which may lead to a burden of treatment. The purpose of this study was to assess the levels of burdens from treatment and self-care and its associations with psychological distress and health-related quality of life. METHODS In this cross-sectional study we collected self-report data from 125 patients diagnosed with HF, New York Heart Association classification II and III, who received care in a nurse-led HF outpatient clinic. Clinical variables were collected from the medical records. Data analyses comprised descriptive statistics and partial correlations. RESULTS The participants mean age was 67 (±9.2), most were male (74,4%) and the majority had reduced ejection fraction (EF 35.4 ± 10.8). The highest mean burden scores emerged for insufficient medical information (34.65, range 0-86), difficulty with health care service (34.57, range 0-81), and physical and mental fatigue (34.12, range 0-90). Significant positive associations were observed between physical and mental fatigue from self-care, role and social activity limitation, and psychological distress, and health-related QoL. CONCLUSION Burden of treatment is an important aspect of HF treatment as it contributes to valuable knowledge on patient workload. This study emphasizes the need to simplify and tailor the treatment regimens to alleviate the burden.
Collapse
Affiliation(s)
- Oda Karin Nordfonn
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, PB 8600 Forus, 4016 Stavanger, Norway.
| | - Ingvild Margreta Morken
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, PB 8600 Forus, 4016 Stavanger, Norway; Department of Cardiology, Stavanger University Hospital, PB 8100, 4068 Stavanger, Norway
| | - Lars Edvin Bru
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, PB 8600 Forus, 4016 Stavanger, Norway
| | - Alf Inge Larsen
- Department of Cardiology, Stavanger University Hospital, PB 8100, 4068 Stavanger, Norway; Department of Clinical Science, University of Bergen, PB 7800, 5020 Bergen, Norway
| | - Anne Marie Lunde Husebø
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, PB 8600 Forus, 4016 Stavanger, Norway
| |
Collapse
|
31
|
Hendricks L, Eshun-Wilson I, Rohwer A. A mega-aggregation framework synthesis of the barriers and facilitators to linkage, adherence to ART and retention in care among people living with HIV. Syst Rev 2021; 10:54. [PMID: 33568216 PMCID: PMC7875685 DOI: 10.1186/s13643-021-01582-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 01/06/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND People living with human immunodeficiency virus (PLHIV) struggle with the challenges of living with a chronic disease and integrating antiretroviral treatment (ART) and care into their daily lives. The aims of this study were as follows: (1) to undertake the first mega-aggregation of qualitative evidence syntheses using the methods of framework synthesis and (2) make sense of existing qualitative evidence syntheses that explore the barriers and facilitators of adherence to antiretroviral treatment, linkage to care and retention in care for PLHIV to identify research gaps. METHODS We conducted a comprehensive search and did all screening, data extraction and critical appraisal independently and in duplicate. We used the Kaufman HIV Behaviour Change model (Kaufman et al., 2014) as a framework to synthesise the findings using the mega-aggregative framework synthesis approach, which consists of 8 steps: (1) identify a clearly defined review question and objectives, (2) identify a theoretical framework or model, (3) decide on criteria for considering reviews for inclusion, (4) conduct searching and screening, (5) conduct quality appraisal of the included studies, (6) data extraction and categorisation, (7) present and synthesise the findings, and (8) transparent reporting. We evaluated systematic reviews up to July 2018 and assessed methodological quality, across reviews, using the Joanna Briggs Institute Critical Appraisal Checklist for Systematic Reviews. RESULTS We included 33 systematic reviews from low, middle- and high-income countries, which reported on 1,111,964 PLHIV. The methodological quality of included reviews varied considerably. We identified 544 unique third-order concepts from the included systematic reviews, which were reclassified into 45 fourth-order themes within the individual, interpersonal, community, institutional and structural levels of the Kaufman HIV Behaviour Change model. We found that the main influencers of linkage, adherence and retention behaviours were psychosocial and personal characteristics-perceptions of ART, desires, fears, experiences of HIV and ART, coping strategies and mental health issues-interwoven with other factors on the interpersonal, community, institutional and structural level. Using this approach, we found interdependence between factors influencing ART linkage, retention and adherence and identified the need for qualitative evidence that explores, in greater depth, the complex relationships between structural factors and adherence, sociodemographic factors such as community violence and retention, and the experiences of growing up with HIV in low- and middle-income countries-specifically in children, youth, women and key populations. CONCLUSIONS This is the first mega-aggregation framework synthesis, or synthesis of qualitative evidence syntheses using the methods of framework synthesis at the overview level. We found the novel method to be a transparent and efficient method for assessing the quality and making sense of existing qualitative systematic reviews. SYSTEMATIC REVIEW REGISTRATION The protocol of this overview was registered on PROSPERO ( CRD42017078155 ) on 17 December 2017.
Collapse
Affiliation(s)
- Lynn Hendricks
- Centre for Evidence-Based Health Care, Division Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Social, Methodological, Innovative, Kreative, Centre for Sociological Research, Faculty of Social Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Ingrid Eshun-Wilson
- Centre for Evidence-Based Health Care, Division Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Anke Rohwer
- Centre for Evidence-Based Health Care, Division Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| |
Collapse
|
32
|
Allen K, Damery SL, Sein K, Johnson DW, Davies SJ, Lambie M, Holvoet E, Combes GM. How do patients and their family members experience the transition from peritoneal dialysis to incentre haemodialysis? A multisite qualitative study in England and Australia. Perit Dial Int 2020; 42:297-304. [PMID: 33331224 DOI: 10.1177/0896860820975596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND While numerous studies have explored the patient experience of dialysis or other end-stage kidney disease (ESKD) treatments, few have explored the process of transitioning between dialysis modalities. This study aimed to develop an in-depth understanding of patient and caregiver perceptions and experiences of the transition from peritoneal to haemodialysis (HD) and to identify ways in which transitions can be optimised. METHODS Fifty-four in-depth, semi-structured interviews were undertaken at six study sites across the West Midlands, UK (n = 23), and Queensland, Australia (n = 31). Thirty-nine participants were patients with ESKD; the remainder were family members. An inductive analytical approach was employed, with findings synthesised across sites to identify themes that transcended country differences. RESULTS Of the 39 patient transitions, only 4 patients reported a wholly negative transition experience. Three cross-cutting themes identified common transition experiences and areas perceived to make a difference to the treatment transition: resistance to change and fear of HD; transition experience shared with family; and bodily adjustment and sense of self. CONCLUSION Although each transition is unique to the individual and their circumstances, kidney care services could optimise the process by recognising these patient-led themes and developing strategies that engage with them. Kidney care services should consider ways to keep patients aware of potential future treatment options and present them objectively. There is potential value in integrating expert support before and during treatment transitions to identify and address patient and family concerns.
Collapse
Affiliation(s)
- Kerry Allen
- Health Services Management Centre, University of Birmingham, Edgbaston, UK
| | - Sarah L Damery
- Institute for Applied Health Research, University of Birmingham, Edgbaston, UK
| | - Kim Sein
- Institute for Applied Health Research, University of Birmingham, Edgbaston, UK
| | - David W Johnson
- Department of Nephrology, Division of Medicine, ARTS Building, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Simon J Davies
- Faculty of Medicine and Health Sciences, Keele University, Staffordshire, UK
| | - Mark Lambie
- Faculty of Medicine and Health Sciences, Keele University, Staffordshire, UK
| | - Els Holvoet
- Renal Division, Ghent University Hospital, Belgium
| | - Gill M Combes
- Institute for Applied Health Research, University of Birmingham, Edgbaston, UK
| |
Collapse
|
33
|
Hounkpatin HO, Leydon GM, Veighey K, Armstrong K, Santer M, Taal MW, Annells P, May C, Roderick PJ, Fraser SD. Patients' and kidney care team's perspectives of treatment burden and capacity in older people with chronic kidney disease: a qualitative study. BMJ Open 2020; 10:e042548. [PMID: 33310810 PMCID: PMC7735091 DOI: 10.1136/bmjopen-2020-042548] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/17/2020] [Accepted: 11/16/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Chronic kidney disease (CKD) is often a multimorbid condition and progression to more severe disease is commonly associated with increased management requirements, including lifestyle change, more medication and greater clinician involvement. This study explored patients' and kidney care team's perspectives of the nature and extent of this workload (treatment burden) and factors that support capacity (the ability to manage health) for older individuals with CKD. DESIGN Qualitative semistructured interview and focus group study. SETTING AND PARTICIPANTS Adults (aged 60+) with predialysis CKD stages G3-5 (identified in two general practitioner surgeries and two renal clinics) and a multiprofessional secondary kidney care team in the UK. RESULTS 29 individuals and 10 kidney team members were recruited. Treatment burden themes were: (1) understanding CKD, its treatment and consequences, (2) adhering to treatments and management and (3) interacting with others (eg, clinicians) in the management of CKD. Capacity themes were: (1) personal attributes (eg, optimism, pragmatism), (2) support network (family/friends, service providers), (3) financial capacity, environment (eg, geographical distance to unit) and life responsibilities (eg, caring for others). Patients reported poor provision of CKD information and lack of choice in treatment, whereas kidney care team members discussed health literacy issues. Patients reported having to withdraw from social activities and loss of employment due to CKD, which further impacted their capacity. CONCLUSION Improved understanding of and measures to reduce the treatment burden (eg, clear information, simplified medication, joined up care, free parking) associated with CKD in individuals as well as assessment of their capacity and interventions to improve capacity (social care, psychological support) will likely improve patient experience and their engagement with kidney care services.
Collapse
Affiliation(s)
- Hilda O Hounkpatin
- Primary Care, Population Sciences and Medical Education, University of Southampton Faculty of Medicine, Southampton, Southampton, UK
| | - Geraldine M Leydon
- Primary Care, Population Sciences and Medical Education, University of Southampton Faculty of Medicine, Southampton, Southampton, UK
| | - Kristin Veighey
- Southampton Academy of Research, University Hospital Southampton NHS Foundation Trust, Southampton, Southampton, UK
| | - Kirsten Armstrong
- Renal Medicine and Nephrology, University Hospital Southampton NHS Foundation Trust, Southampton, Southampton, UK
| | - Miriam Santer
- Primary Care, Population Sciences and Medical Education, University of Southampton Faculty of Medicine, Southampton, Southampton, UK
| | - Maarten W Taal
- Renal Medicine, Royal Derby Hospital, Derby, UK
- Centre for Kidney Research and Innovation, University of Nottingham, Derby, UK
| | | | - Carl May
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, London, UK
| | - Paul J Roderick
- Primary Care, Population Sciences and Medical Education, University of Southampton Faculty of Medicine, Southampton, Southampton, UK
| | - Simon Ds Fraser
- Primary Care, Population Sciences and Medical Education, University of Southampton Faculty of Medicine, Southampton, Southampton, UK
| |
Collapse
|
34
|
Levoy K, Tarbi EC, De Santis JP. End-of-life decision making in the context of chronic life-limiting disease: a concept analysis and conceptual model. Nurs Outlook 2020; 68:784-807. [PMID: 32943221 PMCID: PMC7704858 DOI: 10.1016/j.outlook.2020.07.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 06/26/2020] [Accepted: 07/10/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Conceptual ambiguities prevent advancements in end-of-life decision making in clinical practice and research. PURPOSE To clarify the components of and stakeholders (patients, caregivers, healthcare providers) involved in end-of-life decision making in the context of chronic life-limiting disease and develop a conceptual model. METHOD Walker and Avant's approach to concept analysis. FINDINGS End-of-life decision making is a process, not a discrete event, that begins with preparation, including decision maker designation and iterative stakeholder communication throughout the chronic illness (antecedents). These processes inform end-of-life decisions during terminal illness, involving: 1) serial choices 2) weighed in terms of potential outcomes 3) through patient and caregiver collaboration (attributes). Components impact patients' death, caregivers' bereavement, and healthcare systems' outcomes (consequences). DISCUSSION Findings provide a foundation for improved inquiry into and measurement of the end-of-life decision making process, accounting for the dose, content, and quality the antecedent and attribute factors that collectively contribute to outcomes.
Collapse
Affiliation(s)
- Kristin Levoy
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA.
| | - Elise C Tarbi
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA
| | - Joseph P De Santis
- University of Miami School of Nursing and Health Studies, Coral Gables, FL
| |
Collapse
|
35
|
Corbett TK, Cummings A, Lee K, Calman L, Fenerty V, Farrington N, Lewis L, Young A, Boddington H, Wiseman T, Richardson A, Foster C, Bridges J. Planning and optimising CHAT&PLAN: A conversation-based intervention to promote person-centred care for older people living with multimorbidity. PLoS One 2020; 15:e0240516. [PMID: 33064764 PMCID: PMC7567392 DOI: 10.1371/journal.pone.0240516] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 09/21/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Older people are more likely to be living with cancer and multiple long-term conditions, but their needs, preferences for treatments, health priorities and lifestyle are often not identified or well-understood. There is a need to move towards a more comprehensive person-centred approach to care that focuses on the cumulative impact of a number of conditions on daily activities and quality of life. This paper describes the intervention planning process for CHAT& PLANTM, a structured conversation intervention to promote personalised care and support self-management in older adults with complex conditions. METHODS A theory-, evidence- and person-based approach to intervention development was undertaken. The intervention planning and development process included reviewing relevant literature and existing guidelines, developing guiding principles, conducting a behavioural analysis and constructing a logic model. Optimisation of the intervention and its implementation involved qualitative interviews with older adults with multimorbidity (n = 8), family caregivers (n = 2) and healthcare professionals (HCPs) (n = 20). Data were analysed thematically and informed changes to the intervention prototype. RESULTS Review findings reflected the importance of HCPs taking a person-centred (rather than disease-centred) approach to their work with older people living with multimorbidity. This approach involves HCPs giving health service users the opportunity to voice their priorities, then using these to underpin the treatment and care plan that follow. Findings from the planning stage indicated that taking a structured approach to interactions between HCPs and health service users would enable elicitation of individual concerns, development of a plan tailored to that individual, negotiation of roles and review of goals as individual priorities change. In the optimisation stage, older adults and HCPs commented on the idea of a structured conversation to promote person-centred care and on its feasibility in practice. The idea of a shared, person-centred approach to care was viewed positively. Concerns were raised about possible extra work for those receiving or delivering care, time and staffing, and risk of creating another "tick-box" exercise for staff. Participants concluded that anyone with the appropriate skills could potentially deliver the intervention, but training was likely to be required to ensure correct utilisation and self-efficacy to deliver to the intervention. CONCLUSIONS CHAT&PLAN, a structured person-centred conversation guide appears acceptable and appealing to HCPs and older adults with multimorbidity. Further development of the CHAT&PLAN intervention should focus on ensuring that staff are adequately trained and supported to implement the intervention.
Collapse
Affiliation(s)
- Teresa K. Corbett
- NIHR ARC Wessex, School of Health Sciences, University of Southampton, Highfield, Southampton, United Kingdom
| | - Amanda Cummings
- Macmillan Survivorship Research Group, School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Kellyn Lee
- School of Health Sciences, University of Southampton, Highfield, Southampton, United Kingdom
| | - Lynn Calman
- Macmillan Survivorship Research Group, School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Vicky Fenerty
- University of Southampton Library, University of Southampton, Southampton, United Kingdom
| | - Naomi Farrington
- University Hospital Southampton & University of Southampton, Southampton, United Kingdom
| | - Lucy Lewis
- Health Education England South East, University Hospital Southampton NHS Foundation Trust and University of Southampton, Otterbourne, Winchester, United Kingdom
| | - Alexandra Young
- School of Health Sciences, University of Southampton, Highfield, Southampton, United Kingdom
| | - Hilary Boddington
- Wessex Macmillan GP, Wessex Cancer Alliance, Southampton, United Kingdom
| | - Theresa Wiseman
- The Royal Marsden NHS Foundation Trust and University of Southampton, Southampton, United Kingdom
| | - Alison Richardson
- NIHR ARC Wessex, School of Health Sciences, University of Southampton and University Hospital Southampton NHS Foundation Trust Mailpoint, Southampton General hospital, Southampton, United Kingdom
| | - Claire Foster
- Macmillan Survivorship Research Group, School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Jackie Bridges
- NIHR ARC Wessex, School of Health Sciences, University of Southampton, Southampton, United Kingdom
| |
Collapse
|
36
|
Experiences of caregiving and quality of healthcare among caregivers of patients with complex chronic processes: A qualitative study. Appl Nurs Res 2020; 56:151344. [PMID: 32907769 DOI: 10.1016/j.apnr.2020.151344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 07/12/2020] [Accepted: 08/22/2020] [Indexed: 11/20/2022]
Abstract
Aim To explore the perceptions of main caregivers regarding caring for chronic complex patients in two different regions of Spain. BACKGROUND Spain is a country with an ageing population and a high number of people with chronic diseases. It is well known that the role of the caregiver is important to ensure quality of life and appropriate care. METHODS Qualitative design using focus groups. Five focus groups, from two different regions, were conducted with 22 caregivers of people with chronic complex diseases to explore their personal experience, examine the quality of care received by the patient and their family and to develop strategies for the improvement of the quality of health care. The focus groups were audio and video recorded. The transcriptions of the focus group sessions were exported to qualitative software analysis MAXQDA 2018.2. The qualitative content analysis was based on different analytical cycles. RESULTS In general terms, caregivers would refer to accepting the care of their family members, but they highlight many negative aspects such as tiredness, lack of help and overload of care. They indicated general satisfaction with the health system but indicated that help was insufficient and that strategies to better address the situations of the complex chronic patient should be improved. The main categories observed were: Conclusions. Complex chronic illnesses are increasingly common at present, generating important consequences on the lives of patients and that of their caregivers. The design of any health strategy for facing the dilemma of chronic illnesses, must necessarily include the vision of the caregivers.
Collapse
|
37
|
Corbett T, Cummings A, Calman L, Farrington N, Fenerty V, Foster C, Richardson A, Wiseman T, Bridges J. Self‐management in older people living with cancer and multi‐morbidity: A systematic review and synthesis of qualitative studies. Psychooncology 2020; 29:1452-1463. [DOI: 10.1002/pon.5453] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Teresa Corbett
- School of Health Sciences, Faculty of Environmental and Life Sciences University of Southampton Southampton UK
- NIHR ARC Wessex University of Southampton UK
| | - Amanda Cummings
- Macmillan Survivorship Research Group University of Southampton Southampton UK
| | - Lynn Calman
- Macmillan Survivorship Research Group University of Southampton Southampton UK
| | - Naomi Farrington
- School of Health Sciences, Faculty of Environmental and Life Sciences University of Southampton Southampton UK
- University Hospital Southampton NHS Foundation Trusts Southampton UK
| | - Vicky Fenerty
- University of Southampton Library University of Southampton Southampton UK
| | - Claire Foster
- Macmillan Survivorship Research Group University of Southampton Southampton UK
| | - Alison Richardson
- School of Health Sciences, Faculty of Environmental and Life Sciences University of Southampton Southampton UK
- NIHR ARC Wessex University of Southampton UK
- University Hospital Southampton NHS Foundation Trusts Southampton UK
| | - Theresa Wiseman
- School of Health Sciences, Faculty of Environmental and Life Sciences University of Southampton Southampton UK
- The Royal Marsden NHS Foundation Trust London UK
| | - Jackie Bridges
- School of Health Sciences, Faculty of Environmental and Life Sciences University of Southampton Southampton UK
- NIHR ARC Wessex University of Southampton UK
| |
Collapse
|
38
|
Simsek I, Manemann SM, Yost KJ, Chamberlain AM, Fabbri M, Jiang R, Weston SA, Roger VL. Participation Bias in a Survey of Community Patients With Heart Failure. Mayo Clin Proc 2020; 95:911-919. [PMID: 32370853 PMCID: PMC7213075 DOI: 10.1016/j.mayocp.2019.11.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 11/15/2019] [Accepted: 11/25/2019] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To identify differences between participants and nonparticipants in a survey of physical and psychosocial aspects of health among a population-based sample of patients with heart failure (HF). PATIENTS AND METHODS Residents from 11 Minnesota counties with a first-ever code for HF (International Classification of Diseases, Ninth Revision 428 and Tenth Revision I50) between January 1, 2013, and December 31, 2016, were identified. Participants completed a questionnaire by mail or telephone. Characteristics and outcomes were extracted from medical records and compared between participants and nonparticipants. Response rate was calculated using guidelines of the American Association for Public Opinion Research. The association between nonparticipation and outcomes was examined using Cox proportional hazards regression for death and Andersen-Gill modeling for hospitalizations. RESULTS Among 7911 patients, 3438 responded to the survey (American Association for Public Opinion Research response rate calculated using formula 2 = 43%). Clinical and demographic differences between participants and nonparticipants were noted, particularly for education, marital status, and neuropsychiatric conditions. After a mean ± SD of 1.5±1.0 years after survey administration, 1575 deaths and 5857 hospitalizations occurred. Nonparticipation was associated with a 2-fold increased risk for death (hazard ratio, 2.29; 95% CI, 2.05-2.56) and 11% increased risk for hospitalization (hazard ratio, 1.11; 95% CI, 1.02-1.22) after adjusting for age, sex, time from HF diagnosis to index date, marital status, coronary disease, arrhythmia, hyperlipidemia, diabetes, cancer, chronic kidney disease, arthritis, osteoporosis, depression, and anxiety. CONCLUSION In a large survey of patients with HF, participation was associated with notable differences in clinical and demographic characteristics and outcomes. Examining the impact of participation is critical to draw inference from studies of patient-reported measures.
Collapse
Affiliation(s)
- Irmak Simsek
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | - Kathleen J Yost
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | - Matteo Fabbri
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Ruoxiang Jiang
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Susan A Weston
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Veronique L Roger
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
| |
Collapse
|
39
|
Seljelid B, Varsi C, Solberg Nes L, Stenehjem AE, Bollerslev J, Børøsund E. Content and system development of a digital patient-provider communication tool to support shared decision making in chronic health care: InvolveMe. BMC Med Inform Decis Mak 2020; 20:46. [PMID: 32131808 PMCID: PMC7057594 DOI: 10.1186/s12911-020-1065-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 02/23/2020] [Indexed: 12/22/2022] Open
Abstract
Background Chronic conditions present major health problems, affecting an increasing number of individuals who experience a variety of symptoms that impact their health related quality of life. Digital tools can be of support in chronic conditions, potentially improving patient-provider communication, promoting shared decision making for treatment and care, and possibly even improving patient outcomes. This study aimed to develop a digital tool for patient-provider communication in chronic health care settings and describes the data collection and subsequent content and software development of the InvolveMe tool. InvolveMe will provide patients with the opportunity to report symptoms and preferences to their health care providers (HCP), and to use secure messaging to interact with the HCPs. Method The study employed a combination of interviews with patients with chronic conditions and focus groups with HCPs, examining experiences with chronic conditions and the potential use of a digital tool for support. Participants were recruited from two outpatient clinics at a university hospital. Data collected from interviews and focus groups were analysed using thematic analysis. Content and software development was informed by the data collection and by tool development workshops. Results Analyses from interviews with patients (n = 14) and focus groups with HCPs (n = 11) generated three main themes: 1) Making symptoms and challenges visible, 2) Mastering a new life, and 3) Digital opportunities for follow-up. Each main theme generated separate subthemes. Theme 1 and 2 gave input for content development of the symptom and needs assessment part of the tool, while theme 3 provided ideas for the software development of the InvolveMe tool. Tool development workshops with patients (n = 6) and HCPs (n = 6) supplemented the development. Conclusions A digital tool such as InvolveMe has the potential to support shared decision making for patients with chronic health conditions. Through integration with an existing patient portal such a tool can provide opportunities for meaningful interactions and communication between patients and HCP’s, particularly with regards to symptoms, needs and preferences for care.
Collapse
Affiliation(s)
- Berit Seljelid
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Cecilie Varsi
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - Lise Solberg Nes
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatry & Psychology, College of Medicine & Science, Mayo Clinic, Rochester, MN, USA
| | - Aud-E Stenehjem
- Department of Nephrology, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - Jens Bollerslev
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Section of Specialized Endocrinology, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - Elin Børøsund
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.
| |
Collapse
|
40
|
Nematollahi M, Bagherian B, Sharifi Z, Keshavarz F, Mehdipour-Rabori R. Self-care status in children with congenital heart disease: A mixed-method study. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2020; 33:77-84. [PMID: 32048405 DOI: 10.1111/jcap.12265] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 12/25/2019] [Accepted: 02/02/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Suffering congenital heart disease leads to physical and mental disabilities in children. Children's self-care can result in appropriate care behaviors for limiting disease-induced problems. Given the ability of children to care for themselves, we investigated self-care statues in children who are suffering from congenital heart disease. METHOD This study was conducted using a mixed-method approach and a sequential explanatory design. A cross-sectional study was conducted to assess self-care status in 124 CHD children who were living in Kerman, Iran. In the qualitative phase, the researchers interviewed 13 of these children and three parents using semi-structured in-depth and face-to-face approaches. RESULTS The mean of self-care scores in these school-age children was optimal (10/7 ± 2/6). In the qualitative phase, three main themes were extracted: captive to health issues physical and mental sufferings and wishing for peace of mind. CONCLUSION The results showed that self-care status in these children was optimal. As the main pillar of patient education, nurses can help enhance self-care behaviors and reduce the complications and problems induced by the disease by implementing educational and support interventions for children with CHD and their families.
Collapse
Affiliation(s)
- Monirsadat Nematollahi
- Department of Medical surgical nursing, Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Behnaz Bagherian
- Department of Medical surgical nursing, Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Zahra Sharifi
- Department of Medical surgical nursing, Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Fateme Keshavarz
- Department of Medical surgical nursing, Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Roghayeh Mehdipour-Rabori
- Department of Medical surgical nursing, Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
| |
Collapse
|
41
|
Holvoet E, Verhaeghe S, Davies S, Combes G, François K, Johnson D, Van Biesen W, Van Humbeeck L. Patients' experiences of transitioning between different renal replacement therapy modalities: A qualitative study. Perit Dial Int 2020; 40:548-555. [PMID: 32063183 DOI: 10.1177/0896860819896219] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Different kidney replacement therapy modalities are available to manage end-stage kidney disease, such as home-based dialysis, in-center hemodialysis, and kidney transplantation. Although transitioning between modalities is common, data on how patients experience these transitions are scarce. This study explores patients' perspectives of transitioning from a home-based to an in-center modality. METHODS Patients transitioning from peritoneal dialysis to in-center hemodialysis were purposively selected. Semi-structured interviews were performed, digitally recorded, and transcribed verbatim. Data analysis, consistent with Charmaz' constructivist approach of grounded theory was performed. RESULTS Fifteen patients (10 males; mean age 62 years) participated. The conditions of the transitioning process impacted the participants' experiences, resulting in divergent experiences and associated emotions. Some participants experienced a loss of control due to the therapy-related changes. Some felt tied down and having lost independence, whereas others stated they regained control as they felt relieved from responsibility. This paradox of control was related to the patient having or not having (1) experienced a fit of hemodialysis with their personal lifestyle, (2) a frame of reference, (3) higher care requirements, (4) insight into the underlying reasons for transitioning, and (5) trust in the healthcare providers. CONCLUSIONS Care teams need to offer opportunities to elicit patients' knowledge and fears, dispel myths, forge connections with other patients, and visit the dialysis unit before transition to alleviate anxiety. Interventions that facilitate a sense of control should be grounded in the meaning that the disorder has for the person and how it impacts their sense of self.
Collapse
Affiliation(s)
- Els Holvoet
- Renal Division, 26656Ghent University Hospital, Ghent, Belgium
| | - Sofie Verhaeghe
- Department of Public Health, University Centre for Nursing and Midwifery, 26656Ghent University, Ghent, Belgium
| | - Simon Davies
- Institute of Applied Clinical Science, Keele University, Stoke-on-Trent, UK
| | - Gill Combes
- 522411Institute of applied Health Research, Murray Learning Centre, University of Birmingham, UK
| | - Karlien François
- Division of Nephrology and Arterial Hypertension, 60201Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Laarbeeklaan, Brussels, Belgium
| | - David Johnson
- Department of Nephrology, 1966Princess Alexandra Hospital, Brisbane, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| | - Wim Van Biesen
- Renal Division, 26656Ghent University Hospital, Ghent, Belgium
| | | |
Collapse
|
42
|
Parry M. Caregiver Burden and Cardiovascular Disease: Can We Afford to Keep the Health of Caregivers in Canada Invisible? Can J Cardiol 2019; 35:1267-1269. [PMID: 31515086 DOI: 10.1016/j.cjca.2019.06.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 06/24/2019] [Accepted: 06/25/2019] [Indexed: 11/19/2022] Open
Affiliation(s)
- Monica Parry
- University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
43
|
Smith S, Murphy E, Hannigan C, Dinsmore J, Doyle J. Supporting older people with multimorbidity: The care burden of home health-care assistants in Ireland. Home Health Care Serv Q 2019; 38:241-255. [DOI: 10.1080/01621424.2019.1614506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Suzanne Smith
- NetwellCASALA, Dundalk Institute of Technology, Dundalk, Co. Louth, Ireland
| | - Emma Murphy
- Trinity Centre for Practice and Healthcare Innovation, Trinity College, Dublin, Ireland
| | - Caoimhe Hannigan
- Trinity Centre for Practice and Healthcare Innovation, Trinity College, Dublin, Ireland
| | - John Dinsmore
- Trinity Centre for Practice and Healthcare Innovation, Trinity College, Dublin, Ireland
| | - Julie Doyle
- NetwellCASALA, Dundalk Institute of Technology, Dundalk, Co. Louth, Ireland
| |
Collapse
|
44
|
Dieckelmann M, Reinhardt F, Jeitler K, Semlitsch T, Plath J, Gerlach FM, Siebenhofer A, Petersen JJ. Chronic heart failure patients' experiences of German healthcare services: a protocol for a scoping review. BMJ Open 2019; 9:e025685. [PMID: 30782940 PMCID: PMC6377537 DOI: 10.1136/bmjopen-2018-025685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Chronic heart failure (CHF) is a heterogeneous condition requiring complex treatment from diverse healthcare services. An increasingly holistic understanding of healthcare has resulted in contextual factors such as perceived quality of care, as well as patients' acceptance, preferences and subjective expectations of health services, all gaining in importance. How patients with CHF experience the use of healthcare services has not been studied within the scope of a systematic review in a German healthcare context. The aim of this scoping review is therefore to review systematically the experiences of patients affected by CHF with healthcare services in Germany in the literature and to map the research foci. Further objectives are to identify gaps in evidence, develop further research questions and to inform decision makers concerned with improving healthcare of patients living with CHF. METHODS AND ANALYSIS This scoping review will be based on a broad search strategy involving systematic and comprehensive electronic database searches in MEDLINE, EMBASE, PsycINFO, PSYNDEX, CINAHL and Cochrane's Database of Systematic Reviews, grey literature searches, as well as hand searches through reference lists and non-indexed key journals. The methodological procedure will be based on an established six-stage framework for conducting scoping reviews that includes two independent reviewers. Data will be systematically extracted, qualitatively and quantitatively analysed and summarised both narratively and visually. To ensure the research questions and extracted information are meaningful, a patient representative will be involved. ETHICS AND DISSEMINATION Ethical approval will not be required to conduct this review. Results will be disseminated through a clearly illustrated report that will be part of a wider research project. Furthermore, it is intended that the review's findings should be made available to relevant stakeholders through conference presentations and publication in peer-reviewed journals (knowledge transfer). Protocol registration in PROSPERO is not applicable for scoping reviews.
Collapse
Affiliation(s)
- Mirjam Dieckelmann
- Institute of General Practice, Goethe University Frankfurt, Frankfurt, Germany
| | - Felix Reinhardt
- Institute of General Practice, Goethe University Frankfurt, Frankfurt, Germany
| | - Klaus Jeitler
- Institute of General Practice and Evidence-based Health Services Research, Medical University of Graz, Graz, Austria
| | - Thomas Semlitsch
- Institute of General Practice and Evidence-based Health Services Research, Medical University of Graz, Graz, Austria
| | - Jasper Plath
- Institute of General Practice, Goethe University Frankfurt, Frankfurt, Germany
| | - Ferdinand M Gerlach
- Institute of General Practice, Goethe University Frankfurt, Frankfurt, Germany
| | - Andrea Siebenhofer
- Institute of General Practice, Goethe University Frankfurt, Frankfurt, Germany
- Institute of General Practice and Evidence-based Health Services Research, Medical University of Graz, Graz, Austria
| | - Juliana J Petersen
- Institute of General Practice, Goethe University Frankfurt, Frankfurt, Germany
| |
Collapse
|
45
|
Lippiett KA, Richardson A, Myall M, Cummings A, May CR. Patients and informal caregivers' experiences of burden of treatment in lung cancer and chronic obstructive pulmonary disease (COPD): a systematic review and synthesis of qualitative research. BMJ Open 2019; 9:e020515. [PMID: 30813114 PMCID: PMC6377510 DOI: 10.1136/bmjopen-2017-020515] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To identify, characterise and explain common and specific features of the experience of treatment burden in relation to patients living with lung cancer or chronic obstructive pulmonary disease (COPD) and their informal caregivers. DESIGN Systematic review and interpretative synthesis of primary qualitative studies. Papers were analysed using constant comparison and directed qualitative content analysis. DATA SOURCES CINAHL, EMBASE, MEDLINE, PsychINFO, Scopus and Web of Science searched from January 2006 to December 2015. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Primary qualitative studies in English where participants were patients with lung cancer or COPD and/or their informal caregivers, aged >18 years that contain descriptions of experiences of interacting with health or social care in Europe, North America and Australia. RESULTS We identified 127 articles with 1769 patients and 491 informal caregivers. Patients, informal caregivers and healthcare professionals (HCPs) acknowledged lung cancer's existential threat. Managing treatment workload was a priority in this condition, characterised by a short illness trajectory. Treatment workload was generally well supported by an immediacy of access to healthcare systems and a clear treatment pathway. Conversely, patients, informal caregivers and HCPs typically did not recognise or understand COPD. Treatment workload was balanced with the demands of everyday life throughout a characteristically long illness trajectory. Consequently, treatment workload was complicated by difficulties of access to, and navigation of, healthcare systems, and a fragmented treatment pathway. In both conditions, patients' capacity to manage workload was enhanced by the support of family and friends, peers and HCPs and diminished by illness/smoking-related stigma and social isolation. CONCLUSION This interpretative synthesis has affirmed significant differences in treatment workload between lung cancer and COPD. It has demonstrated the importance of the capacity patients have to manage their workload in both conditions. This suggests a workload which exceeds capacity may be a primary driver of treatment burden. PROSPERO REGISTRATION NUMBER CRD42016048191.
Collapse
Affiliation(s)
- Kate Alice Lippiett
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Alison Richardson
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Michelle Myall
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Amanda Cummings
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Carl R May
- London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
46
|
Fasolino T. Addressing Challenges of Patients With Chronic Pulmonary Disease Using Makerspace Environments. Creat Nurs 2019; 25:46-52. [DOI: 10.1891/1078-4535.25.1.46] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Patients with chronic progressive pulmonary disease suffer from physiological and psychological consequences. These patients experience functional disability, depression and anxiety, and decreased quality of life. Their ability to perform activities of daily living can be severely impaired. Direct patient care nurses are well suited to assist these patients and their caregivers, identifying challenges through interactions and active listening and assisting in the identification of solutions. Even simple solutions to everyday issues can reduce the disease burden for this population. This article describes how direct patient care nurses can address the challenges of these patients through an innovative environment known as a makerspace.
Collapse
|
47
|
Macdonald S, Conway E, Bikker A, Browne S, Robb K, Campbell C, Steele RJ, Weller D, Macleod U. Making sense of bodily sensations: Do shared cancer narratives influence symptom appraisal? Soc Sci Med 2019; 223:31-39. [PMID: 30703697 DOI: 10.1016/j.socscimed.2018.12.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 12/04/2018] [Accepted: 12/23/2018] [Indexed: 01/22/2023]
Abstract
Though new or altered bodily sensations are a common occurrence they rarely transition to biomedically defined symptoms. When they do, sensations are subject to an appraisal process that can culminate in help-seeking. The transition has particular relevance for cancer diagnoses. Studies of 'symptom appraisal' in cancer patients typically conclude that failure to regard sensations as serious or 'symptom misattribution' results in lengthier help-seeking intervals. Though multiple influences on appraisal processes are acknowledged, including the socio-cultural context, detailed description and analyses of how socio-cultural factors shape appraisal is lacking. In this paper we explore one substantial component of the sociocultural context, namely, publicly recognised shared cancer narratives, and their impact on appraisal. We undertook a secondary analysis of 24 interviews with Scottish colorectal cancer patients originally completed in 2006-2007. Our analysis showed that fear, death and severity dominated cancer narratives and were frequently restated throughout interviews. Yet, early bodily changes were often mild and vague, were commonly experienced in the context of 'feeling well' and failed to match preconceived ideas of what cancer 'feels like'. Moreover, few perceived themselves to be 'at risk' of cancer and diagnoses were characterised as 'shocking' events. Participants engaged in self-monitoring strategies and severe or painful changes prompted help-seeking. Far from misattributing symptoms, responses to bodily changes were sensible and measured; responses are particularly apt in relation to current policy rhetoric, which urges measured use of services. Our findings have resonance across healthcare settings as patients are required to negotiate a narrow and challenging space when making decisions to seek help. There is a pressing need for a more realistic approach to symptom appraisal in order to reduce help-seeking intervals. Future awareness campaigns should emphasise the importance of vague/minor bodily changes although this will necessitate discussions with health professionals on referral thresholds to achieve earlier detection.
Collapse
Affiliation(s)
- Sara Macdonald
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 8QQ, UK.
| | - Elaine Conway
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Annemieke Bikker
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Susan Browne
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Kathryn Robb
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Christine Campbell
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Robert Jc Steele
- Medical Research Institute, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, UK
| | - David Weller
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Una Macleod
- Hull York Medical School, University of Hull, Hull, HU6 7RX, UK
| |
Collapse
|
48
|
Inadequate Communication Exacerbates the Support Needs of Current and Bereaved Caregivers in Advanced Heart Failure and Impedes Shared Decision-making. J Cardiovasc Nurs 2019; 34:11-19. [DOI: 10.1097/jcn.0000000000000516] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
49
|
Lo C, Sarker T, Canning O, Martin V, McCarthy MA, Granton J, Tan A. Clinical presentation of existential distress in pulmonary arterial hypertension. CANADIAN JOURNAL OF RESPIRATORY CRITICAL CARE AND SLEEP MEDICINE 2018. [DOI: 10.1080/24745332.2018.1507614] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Chris Lo
- Psychology, University of Guelph-Humber, Toronto, Canada
- Psychiatry, University of Toronto, Toronto, Canada
- Institute for Life Course and Aging, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
- Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Social and Behavioural Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Tasmie Sarker
- Psychology, University of Guelph-Humber, Toronto, Canada
- Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Orla Canning
- Psychology, University of Guelph-Humber, Toronto, Canada
- Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Vanessa Martin
- Psychology, University of Guelph-Humber, Toronto, Canada
- Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Mary A. McCarthy
- Pulmonary Hypertension Program, Toronto General Hospital, University Health Network, Toronto, Canada
| | - John Granton
- Pulmonary Hypertension Program, Toronto General Hospital, University Health Network, Toronto, Canada
| | - Adrienne Tan
- Psychiatry, University of Toronto, Toronto, Canada
- Pulmonary Hypertension Program, Toronto General Hospital, University Health Network, Toronto, Canada
| |
Collapse
|
50
|
Roberti J, Cummings A, Myall M, Harvey J, Lippiett K, Hunt K, Cicora F, Alonso JP, May CR. Work of being an adult patient with chronic kidney disease: a systematic review of qualitative studies. BMJ Open 2018; 8:e023507. [PMID: 30181188 PMCID: PMC6129107 DOI: 10.1136/bmjopen-2018-023507] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/28/2018] [Accepted: 08/08/2018] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Chronic kidney disease (CKD) requires patients and caregivers to invest in self-care and self-management of their disease. We aimed to describe the work for adult patients that follows from these investments and develop an understanding of burden of treatment (BoT). METHODS Systematic review of qualitative primary studies that builds on EXPERTS1 Protocol, PROSPERO registration number: CRD42014014547. We included research published in English, Spanish and Portuguese, from 2000 to present, describing experience of illness and healthcare of people with CKD and caregivers. Searches were conducted in MEDLINE, Embase, CINAHL Plus, PsycINFO, Scopus, Scientific Electronic Library Online and Red de Revistas Científicas de América Latina y el Caribe, España y Portugal. Content was analysed with theoretical framework using middle-range theories. RESULTS Searches resulted in 260 studies from 30 countries (5115 patients and 1071 carers). Socioeconomic status was central to the experience of CKD, especially in its advanced stages when renal replacement treatment is necessary. Unfunded healthcare was fragmented and of indeterminate duration, with patients often depending on emergency care. Treatment could lead to unemployment, and in turn, to uninsurance or underinsurance. Patients feared catastrophic events because of diminished financial capacity and made strenuous efforts to prevent them. Transportation to and from haemodialysis centre, with variable availability and cost, was a common problem, aggravated for patients in non-urban areas, or with young children, and low resources. Additional work for those uninsured or underinsured included fund-raising. Transplanted patients needed to manage finances and responsibilities in an uncertain context. Information on the disease, treatment options and immunosuppressants side effects was a widespread problem. CONCLUSIONS Being a person with end-stage kidney disease always implied high burden, time-consuming, invasive and exhausting tasks, impacting on all aspects of patients' and caregivers' lives. Further research on BoT could inform healthcare professionals and policy makers about factors that shape patients' trajectories and contribute towards a better illness experience for those living with CKD. PROSPERO REGISTRATION NUMBER CRD42014014547.
Collapse
Affiliation(s)
- Javier Roberti
- FINAER, Foundation for Research and Assistance of Kidney Disease, Buenos Aires, Argentina
| | - Amanda Cummings
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Michelle Myall
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Jonathan Harvey
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Kate Lippiett
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Katherine Hunt
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Federico Cicora
- FINAER, Foundation for Research and Assistance of Kidney Disease, Buenos Aires, Argentina
| | - Juan Pedro Alonso
- Faculty of Social Sciences, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Carl R May
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London, UK
| |
Collapse
|