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Ma C. The mediating effect of uncertainty in illness between heart failure symptoms and health-related quality of life among rural patients with heart failure: A multi-center cross-sectional study. Heart Lung 2024; 66:71-77. [PMID: 38593676 DOI: 10.1016/j.hrtlng.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND The health-related quality of life (HRQoL) of patients with heart failure (HF) in rural settings in China remains unclear. Limited studies explored the mediating effect of uncertainty in illness between heart failure symptoms and HRQoL in this population. OBJECTIVES To explore the status of HRQoL in rural patients with HF; assess the impact of HF symptoms and uncertainty in illness on HRQoL; and examine the mediating effect of uncertainty in illness on the relationship between symptoms and HRQoL in rural patients with HF. METHODS Overall, 298 rural patients with HF were recruited from five township hospitals of Taishan and Jinzhong City in China between November 2021 and August 2022. Three variables, namely HF symptoms, uncertainty in illness, and HRQoL were measured using three validated scales. RESULTS The average score of HRQoL in rural patients with HF was 43.19. Of the participants, 60.4 %, 35.23 %, and 4.37 % exhibited poor, moderate, and good HRQoL, respectively. The HF symptoms (β = -0.47) and uncertainty in illness (β = -0.34) directly influenced HRQoL. Moreover, the HF symptoms also indirectly affected HRQoL through uncertainty in illness (β = -0.07). The indirect effect accounted for 12.96 % of the total effect of HF symptoms on HRQoL. CONCLUSION Rural patients with HF exhibited poor HRQoL. In this population, HF symptoms and uncertainty in illness were negatively associated with HRQoL. Uncertainty in illness mediated the relationship between HF symptoms and HRQoL. Tailored healthcare services should be developed for the rural population to alleviate HF symptoms, reduce uncertainty in illness, and enhance their HRQoL.
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Affiliation(s)
- Chunhua Ma
- School of Nursing, Guangzhou Medical University, 195 Dongfengxi Rd., Guangzhou, Guangdong 510180, China.
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Kiddle SJ, Sundell KA, Perl S, Nolan S, Bjursell M. Urate-lowering therapy in patients with hyperuricemia and heart failure: A retrospective cohort study using the UK Clinical Practice Research Datalink. Clin Cardiol 2024; 47:e24297. [PMID: 38873862 DOI: 10.1002/clc.24297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 05/15/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Elevated serum uric acid (sUA) is associated with heart failure (HF). HYPOTHESIS Urate-lowering therapy (ULT) in HF is associated with lower risk of HF hospitalization (hHF) and mortality. METHODS Data on patients with HF and gout or hyperuricemia in the Clinical Practice Research Datalink database linked to the Hospital Episode Statistics and the Office for National Statistics in the United Kingdom were analyzed. Risks of hHF and all-cause mortality or cardiovascular-related mortality by ULT exposure (ULT initiated within ≤6 months of gout or hyperuricemia diagnosis) were analyzed in a propensity score-matched cohort using adjusted Cox proportional hazards regression models. RESULTS Of 2174 propensity score-matched pairs, patients were predominantly male, aged >70 years, with mean ± standard deviation sUA 9.3 ± 1.8 (ULT-exposed) and 9.4 ± 1.9 mg/dL (ULT-unexposed). At 5 years, ULT-exposed patients had a 43% lower risk of hHF or all-cause mortality (adjusted hazard ratio [HR]: 0.57; 95% confidence interval [CI]: 0.51-0.65) and a 19% lower risk of hHF or cardiovascular-related mortality (adjusted HR: 0.81; 95% CI: 0.71-0.92) versus no ULT exposure. CONCLUSION ULT was associated with reduced risk of adverse clinical outcomes in patients with HF and gout or hyperuricemia over 5 years.
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Affiliation(s)
- Steven J Kiddle
- Data Science & Advanced Analytics, Data Science & Artificial Intelligence, R&D, AstraZeneca, Cambridge, UK
| | - Karolina Andersson Sundell
- Cardiovascular, Renal and Metabolic (CVRM) Evidence, BioPharmaceuticals Medical, AstraZeneca, Gothenburg, Sweden
| | - Shira Perl
- Late-stage Development, Clinical, Cardiovascular, Renal and Metabolic (CVRM), BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, Maryland, USA
| | - Stephen Nolan
- Late-stage Development, Clinical, Cardiovascular, Renal and Metabolic (CVRM), BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Magnus Bjursell
- Global Medical Affairs, Clinical, Cardiovascular, Renal and Metabolic (CVRM), BioPharmaceuticals Medical, AstraZeneca, Gothenburg, Sweden
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Jeong H, Lee Y, Park JS, Lee Y. Influence of Illness Uncertainty on Health Behavior in Individuals with Coronary Artery Disease: A Path Analysis. J Korean Acad Nurs 2024; 54:162-177. [PMID: 38863186 DOI: 10.4040/jkan.23136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 03/22/2024] [Accepted: 04/15/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE This study aimed to investigate the influence of uncertainty-related factors on the health behavior of individuals with coronary artery disease (CAD) based on Mishel's uncertainty in illness theory (UIT). METHODS We conducted a cross-sectional study and path analysis to investigate uncertainty and factors related to health behavior. The study participants were 228 CAD patients who visited the outpatient cardiology department between September 2020 and June 2021. We used SPSS 25.0 and AMOS 25.0 software to analyze the data. RESULTS The final model demonstrated a good fit with the data. Eleven of the twelve paths were significant. Uncertainty positively affected danger and negatively affected self-efficacy and opportunity. Danger had a positive effect on perceived risk. Opportunity positively affected social support, self-efficacy, perceived benefit and intention, whereas it negatively affected perceived risk. Social support, self-efficacy, perceived benefit and intention had a positive effect on health behavior. We found that perceived benefit and intention had the most significant direct effects, whereas self-efficacy indirectly affected the relationship between uncertainty and health behavior. CONCLUSION The path model is suitable for predicting the health behavior of CAD patients who experience uncertainty. When patients experience uncertainty, interventions to increase their self-efficacy are required first. Additionally, we need to develop programs that quickly shift to appraisal uncertainty as an opportunity, increase perceived benefits of health behavior, and improve intentions.
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Affiliation(s)
- Hyesun Jeong
- Department of Nursing, Graduate School, Pusan National University, Yangsan, Korea
| | - Yesul Lee
- Department of Nursing, Graduate School, Pusan National University, Yangsan, Korea
| | - Jin Sup Park
- Department of Cardiology, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Yoonju Lee
- College of Nursing, Research Institute of Nursing Science, Pusan National University, Yangsan, Korea.
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Wang X, Hu JX, Wang Y, Wang F, Wu X, Wang F, Zhao YC, Wang XL, Zhang LL. Correlation Between Illness Uncertainty in Caregivers of Patients with Liver Cancer, Their Coping Styles, and Quality of Life. J Multidiscip Healthc 2024; 17:1541-1548. [PMID: 38623394 PMCID: PMC11016459 DOI: 10.2147/jmdh.s441626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 03/21/2024] [Indexed: 04/17/2024] Open
Abstract
Objective This study explores the correlation between coping style, quality of life, and illness uncertainty in the family caregivers of patients with liver cancer. Methods Employing convenience sampling, 210 family caregivers of patients with liver cancer who met the admission criteria were selected from a grade A infectious disease hospital in Beijing between January and December 2022. A cross-sectional survey was conducted using the Simplified Coping Style Questionnaire, Caregiver Quality of Life, and the Mishel Uncertainty in Illness Scale for Family Members. This study analysed the correlations between coping styles, quality of life, and illness uncertainty in these caregivers. Results The study found that family caregivers of patients with liver cancer had average scores for illness uncertainty (83.44 ± 11.86), coping style (33.19 ± 9.79; both positive [23.02 ± 6.81] and negative [10.17 ± 5.05]), and quality of life (169.53 ± 32.46). A negative association was observed between illness uncertainty in these caregivers and positive coping style (r = -0.207, p = 0.003), physical status (r = -0.182, p = 0.008), psychological status (r = -0.200, p = 0.004), and social adaptation (r = -0.229, p = 0.001). Conclusion The study concludes that illness uncertainty in family caregivers of patients with liver cancer is at a moderate level. Furthermore, there is a notable correlation between illness uncertainty, coping style, and quality of life in these caregivers.
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Affiliation(s)
- Xuan Wang
- Second Department of Hepatology Center for Liver Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, People’s Republic of China
| | - Jing-Xian Hu
- Department of Nursing, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, People’s Republic of China
| | - Ying Wang
- Second Department of Hepatology Center for Liver Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, People’s Republic of China
| | - Fang Wang
- Second Department of Hepatology Center for Liver Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, People’s Republic of China
| | - Xuan Wu
- Second Department of Hepatology Center for Liver Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, People’s Republic of China
| | - Fei Wang
- Second Department of Hepatology Center for Liver Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, People’s Republic of China
| | - Yan-Chao Zhao
- Second Department of Hepatology Center for Liver Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, People’s Republic of China
| | - Xiao-Lan Wang
- Department of Nursing, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, People’s Republic of China
| | - Li-Li Zhang
- Department of Nursing, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, People’s Republic of China
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Whittal A, Ehringfeld I, Steinhoff P, Herber OR. Determining Contextual Factors for a Heart Failure Self-Care Intervention: A Consensus Delphi Study (ACHIEVE). HEALTH EDUCATION & BEHAVIOR 2024; 51:311-320. [PMID: 34605710 PMCID: PMC10981183 DOI: 10.1177/10901981211043116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is a rising recognition of the crucial role self-care plays in managing heart failure (HF). Yet patients often have difficulties implementing ongoing self-care recommendations into their daily lives. There is also recognition of the importance of theory for successful intervention design, and understanding of key factors for implementation so interventions fit a given context. Local key stakeholders can provide valuable insights to help understand relevant context-specific factors for intervention implementation. This study sought to engage stakeholders to explore and determine relevant contextual factors needed to design and facilitate successful implementation of an HF self-care intervention in the German health care system. A ranking-type Delphi approach was used to establish consensus from stakeholders (i.e., clinicians, patients, policymakers/potential funders) regarding eight factors (content, interventionist, target group, location, mode of delivery, intensity, duration, and format) to adequately define the components and implementation strategy of the intervention. Seventeen participants were invited to participate in the first Delphi round. A response rate of 94% (16/17) was achieved and maintained for all three Delphi rounds. Stakeholder consensus determined that nurses specializing in HF are the most appropriate interventionists, target groups should include patients and carers, and the intervention should occur in an outpatient HF clinic, be a mixture of group and individual training sessions, and last for 30 minutes. Sessions should take place more frequently in the beginning and less often over time. Local stakeholders can help determine contextual factors that must be taken into account for successful delivery of an intervention. This enables the intervention to be developed and applied based on these factors, to make it suitable for the target context and to enhance participation to achieve the desired outcomes.
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Affiliation(s)
- Amanda Whittal
- Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Witten/Herdecke University, Witten, Germany
| | | | | | - Oliver Rudolf Herber
- Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Witten/Herdecke University, Witten, Germany
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Ingadottir B, Jaarsma T, Norland K, Ketilsdóttir A. Sense of Security Mediates the Relationship Between Self-care Behavior and Health Status of Patients With Heart Failure: A Cross-sectional Study. J Cardiovasc Nurs 2023; 38:537-545. [PMID: 37816081 DOI: 10.1097/jcn.0000000000000981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
BACKGROUND Promoting patients' sense of security is among the goals of nursing care within heart failure management. OBJECTIVE The aim of this study was to examine the role of sense of security in the relationship between self-care behavior and health status of patients with heart failure. METHODS Patients recruited from a heart failure clinic in Iceland answered a questionnaire about their self-care (European Heart Failure Self-care Behavior Scale; possible scores, 0-100), their sense of security (Sense of Security in Care-Patients' Evaluation; possible scores, 1-100), and their health status (Kansas City Cardiomyopathy Questionnaire, including symptoms, physical limitations, quality of life, social limitations, and self-efficacy domains; possible scores, 0-100). Clinical data were extracted from electronic patient records. Regression analysis was used to examine the mediation effect of sense of security on the relationship between self-care and health status. RESULTS The patients (N = 220; mean [SD] age, 73.6 [13.8] years; 70% male, 49% in New York Heart Association functional class III) reported a high sense of security (mean [SD], 83.2 [15.2]) and inadequate self-care (mean [SD], 57.2 [22.0]); their health status, as assessed by all domains of the Kansas City Cardiomyopathy Questionnaire, was fair to good except for self-efficacy, which was good to excellent. Self-care was associated with health status ( P < .01) and sense of security ( P < .001). Regression analysis confirmed the mediating effect of sense of security on the relationship between self-care and health status. CONCLUSIONS Sense of security in patients with heart failure is an important part of daily life and contributes to better health status. Heart failure management should not only support self-care but also aim to strengthen sense of security through positive care interaction (provider-patient communication) and the promotion of patients' self-efficacy, and by facilitating access to care.
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Shen H, Masingboon K, Samartkit N. Factors related to preoperative uncertainty among patients with breast cancer in Wenzhou, China: A cross-sectional study. BELITUNG NURSING JOURNAL 2023; 9:236-243. [PMID: 37492757 PMCID: PMC10363974 DOI: 10.33546/bnj.2648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/30/2023] [Accepted: 06/02/2023] [Indexed: 07/27/2023] Open
Abstract
Background One of the most prevalent psychological signs of breast cancer is uncertainty, which is more prevalent in Chinese patients during the preoperative period. Despite the numerous factors contributing to preoperative uncertainty, there is limited relevant research conducted in China. Objective This study aimed to describe the current state of preoperative uncertainty and to investigate the relationship between anxiety, illness perception, social support, and preoperative uncertainty in patients with breast cancer in Wenzhou, China. Methods This cross-sectional research used a simple random sampling technique to select 122 participants from a university hospital in Wenzhou, China, from July 2022 to December 2022, employing validated instruments. Descriptive statistics and Pearson's correlation coefficient were utilized to analyze the data. Results The average preoperative uncertainty scores of the patients fell within a moderate range (M = 61.92, SD = 7.51). Significant correlations were found between anxiety (r = 0.638, p <0.01), illness perception (r = 0.704, p <0.01), social support (r = -0.481, p <0.01), and preoperative uncertainty. Conclusions The results can assist healthcare professionals, especially nurses, in recognizing the factors contributing to uncertainty before surgery in patients with breast cancer. This knowledge enables them to promptly address and minimize this issue, leading to improved outcomes.
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Affiliation(s)
- Huaiyu Shen
- Faculty of Nursing, Burapha University, Chon Buri, Thailand
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Murphy BM, Rogerson MC, Hesselson S, Iismaa SE, Graham RM, Jackson AC. Psychosocial impacts of spontaneous coronary artery dissection: A qualitative study. PLoS One 2022; 17:e0273978. [PMID: 36067201 PMCID: PMC9447895 DOI: 10.1371/journal.pone.0273978] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 08/18/2022] [Indexed: 12/17/2022] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is an increasingly recognised cause of acute myocardial infarction, particularly in younger women without classic cardiac risk factors. While recent quantitative studies have noted high anxiety and depression in SCAD survivors, the full range and extent of psychosocial impacts of SCAD is unknown. The present study used a qualitative approach to investigate the psychosocial impacts of SCAD in Australian SCAD survivors. Focus group participants were recruited as part of a larger study of SCAD survivors currently being undertaken by the Victor Chang Cardiac Research Institute. Thirty SCAD survivors participated in one of seven online focus groups, conducted using a semi-structured format. Focus group duration was 1.5 hours. Each was digitally recorded and transcribed. Data were analyzed thematically according to recommended guidelines. One over-arching theme, five main themes and 26 sub-themes were identified. The over-arching theme related to lack of information, while the five main themes related to emotional impacts, issues with self-management, issues with family, impacts on work life, and the need for psychosocial support. The ‘emotional impacts’ theme comprised 11 sub-themes, namely shock and disbelief, confusion and uncertainty, unfairness, fear and anxiety, loss and grief, isolation and loneliness, guilt, invalidation and embarrassment, depression, vulnerability, and frustration. Findings are discussed in light of relevant psychological theories. This qualitative study extends previous quantitative investigations of SCAD survivors by providing an in-depth understanding of the complex, inter-related and highly distressing impacts of SCAD. The findings point to the urgent need for a coherent approach to information provision, the development and delivery of SCAD-specific cardiac rehabilitation programs, and the provision of psychosocial support programs for SCAD survivors.
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Affiliation(s)
- Barbara M. Murphy
- Australian Centre for Heart Health, Melbourne, Victoria, Australia
- Faculty of Health, Deakin University, Geelong, Victoria, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
- * E-mail:
| | | | | | - Siiri E. Iismaa
- Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia
- St Vincent’s Clinical School, University of New South Wales, Sydney, Australia
| | - Robert M. Graham
- Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia
- St Vincent’s Clinical School, University of New South Wales, Sydney, Australia
| | - Alun C. Jackson
- Australian Centre for Heart Health, Melbourne, Victoria, Australia
- Faculty of Health, Deakin University, Geelong, Victoria, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
- Center on Behavioral Health, University of Hong Kong, Pokfulam, Hong Kong
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Howe EG. Seeing the Invisible. THE JOURNAL OF CLINICAL ETHICS 2022. [DOI: 10.1086/jce2022332081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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10
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Rees M, Kiemle G, Slade P. Psychological variables and quality of life in women with endometriosis. J Psychosom Obstet Gynaecol 2022; 43:58-65. [PMID: 32706632 DOI: 10.1080/0167482x.2020.1784874] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Endometriosis is a common gynecological condition which has been found to have a detrimental impact upon women's quality of life (QoL). This study investigated the impact of pain self-efficacy, health locus of control (HLOC), coping style and illness uncertainty on QoL in women with endometriosis. METHOD Two hundred and thirty women completed online questionnaires. Standard multiple regressions assessed the relationship between the psychological predictors and QoL. RESULTS The psychological variables accounted for a statistically significant proportion of the variance (p < .0005) in scores across the four QoL domains. The model accounted for 55, 26, 10 and 32% of the scores in physical, psychological, social and environmental QoL domains, respectively. Pain self-efficacy made the largest unique contribution, followed by illness uncertainty. CONCLUSIONS Women's perception of their ability to manage their pain and how uncertain they felt about their condition, were important factors in QoL, particularly in the physical domain.
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Affiliation(s)
- Madeleine Rees
- Clinical Health Psychology Service, Hywel Dda University Health Board, Carmarthen, UK
| | - Gundi Kiemle
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Pauline Slade
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
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Cheng J, Yang D, Zuo Q, Peng W, Zhu L, Jiang X. Correlations between uncertainty in illness and anxiety, depression and quality of life in patients receiving maintenance haemodialysis: A cross-sectional study. Nurs Open 2022; 9:1322-1331. [PMID: 35088576 PMCID: PMC8859091 DOI: 10.1002/nop2.1177] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 11/29/2021] [Accepted: 01/09/2022] [Indexed: 02/05/2023] Open
Abstract
Aim To investigate the uncertainty in illness, anxiety, depression and quality of life in patients receiving maintenance haemodialysis and confirm the correlations between these variables. Design A cross‐sectional study was conducted among 396 patients receiving maintenance haemodialysis in four tertiary hospitals in China. Methods Uncertainty in illness was measured by Mishel's uncertainty in illness scale. The scores of self‐rating anxiety scale, self‐rating depression scale and medical outcomes study short form 36 were collected and compared with available norms. The Pearson correlation coefficient was calculated to investigate the correlation between uncertainties in illness with these vital variables. Results The mean score of uncertainty in illness was 78.16 out of 160. Compared with the norm, patients receiving maintenance haemodialysis had a statistically significantly lower score of depression and higher scores of most domains of quality of life. Uncertainty in illness is corrected with anxiety, depression positively and with quality of life negatively.
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Affiliation(s)
- Jingxia Cheng
- West China School of Nursing, Sichuan University/ West China Hospital, Sichuan University, China
| | - Dongju Yang
- West China School of Nursing, Sichuan University/ West China Hospital, Sichuan University, China
| | - Qiantao Zuo
- West China School of Nursing, Sichuan University/ West China Hospital, Sichuan University, China
| | - Weixu Peng
- West China School of Nursing, Sichuan University/ West China Hospital, Sichuan University, China
| | - Longling Zhu
- West China School of Nursing, Sichuan University/ West China Hospital, Sichuan University, China
| | - Xiaolian Jiang
- West China School of Nursing, Sichuan University/ West China Hospital, Sichuan University, China
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Zhang C, Wang W, Pei Y, Zhang Y, He C, Wang J, Gao X, Hou H. Benevolent Childhood Experiences and Depressive Symptoms Among Chinese Undergraduates: A Moderated Mediation Model Examining the Roles of Uncertainty Stress and Family Relationship. Front Public Health 2021; 9:757466. [PMID: 34976921 PMCID: PMC8716588 DOI: 10.3389/fpubh.2021.757466] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The evidence on the association between benevolent childhood experience (BCE) and depressive symptoms in students is complex. This study aims to explore the underlying mediation mechanism of BCE toward depressive symptoms and whether this link was moderated by the family relationship among Chinese undergraduates. Methods: From March 2021 to May 2021, a cross-sectional study was conducted in China, and 1821 undergraduates were recruited in this study. Participants were asked to complete a self-reported electronic questionnaire. The software SPSS PROCESS macro was used to test the mediation and mediated moderated modeling analysis. Results: Mediation analysis indicated that uncertainty stress (US) partly mediated the link between BCE and depressive symptoms (indirect effect = −0.47, 95% bootstrap CI = −0.55, −0.39). The indirect effect of the US accounted for 39.63% of the total variance in depression. Moderation analysis indicated that the association between the US and depressive symptoms was significantly modified by family relationships (interact effect = −0.019, P < 0.001). An integrative moderated mediation analysis indicated that the indirect effect from BCE to depressive symptoms through the US was also moderated by family relationships (interact effect = −0.012, P = 0.014). Conclusion: Uncertainty stress plays a key role in bridging BCE and depressive symptoms while the family relationship can buffer the impact of the US on depressive symptoms among Chinese undergraduates. Enhancing tolerance of uncertainty and improving family relationships are needed to protect undergraduates from depressive symptoms.
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Affiliation(s)
- Caiyi Zhang
- Department of Medical Psychology, Second Clinical College, Xuzhou Medical University, Xuzhou, China
- Department of Psychiatry, The Affiliated Xuzhou Oriental Hospital of Xuzhou Medical University, Xuzhou, China
| | - Wei Wang
- Department of Community and Health Education, School of Public Health, Xuzhou Medical University, Xuzhou, China
- Wei Wang
| | - Yifei Pei
- Department of Community and Health Education, School of Public Health, Xuzhou Medical University, Xuzhou, China
| | - Ying Zhang
- Department of Community and Health Education, School of Public Health, Xuzhou Medical University, Xuzhou, China
| | - Chenlu He
- Department of Community and Health Education, School of Public Health, Xuzhou Medical University, Xuzhou, China
| | - Jingjing Wang
- Department of Community and Health Education, School of Public Health, Xuzhou Medical University, Xuzhou, China
| | - Xiuyin Gao
- Department of Community and Health Education, School of Public Health, Xuzhou Medical University, Xuzhou, China
| | - Hao Hou
- Department of Community and Health Education, School of Public Health, Xuzhou Medical University, Xuzhou, China
- *Correspondence: Hao Hou
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Cui C, Li Y, Wang L. The Association of Illness Uncertainty and Hope With Depression and Anxiety Symptoms in Women With Systemic Lupus Erythematosus: A Cross-sectional Study of Psychological Distress in Systemic Lupus Erythematosus Women. J Clin Rheumatol 2021; 27:299-305. [PMID: 32084070 DOI: 10.1097/rhu.0000000000001280] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Depression and anxiety are commonly observed psychological symptoms in patients diagnosed with systemic lupus erythematosus (SLE). This study aimed to explore the possible factors that influence depression and anxiety symptoms development in SLE women. METHODS This cross-sectional study was conducted between October 2017 and December 2018 in Liaoning, China. Questionnaires including Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Mishel Uncertainty in Illness Scale for Adults, and Herth Hope Scale were completed by 205 participants. Factors related to depression and anxiety were examined using hierarchical multiple regression analysis, while the effect of hope was examined using structural equation model. RESULTS The prevalence of depression and anxiety symptoms in female SLE patients was 79.5% and 86.8%, respectively. Illness uncertainty was strongly positively correlated with depression and anxiety symptoms. In contrast, hope was negatively associated with depression and anxiety symptoms. Up to 66.6% and 59.4% of the variance explained by all the variables was 66.6% in depression symptoms and 59.4% in anxiety symptoms. Interestingly, hope was able to alter the relationship of illness uncertainty with depression and anxiety symptoms. CONCLUSIONS While illness uncertainty can increase depression and anxiety symptoms, hope can reduce these symptoms. Therefore, hope-based targeted interventions should be employed to prevent and treat depression and anxiety symptoms among SLE women.
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Affiliation(s)
- Chunying Cui
- From the Department of Social Medicine, School of Public Health, China Medical University, Shenyang, China
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Lawless MT, Tieu M, Feo R, Kitson AL. Theories of self-care and self-management of long-term conditions by community-dwelling older adults: A systematic review and meta-ethnography. Soc Sci Med 2021; 287:114393. [PMID: 34534780 DOI: 10.1016/j.socscimed.2021.114393] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 09/02/2021] [Accepted: 09/08/2021] [Indexed: 02/03/2023]
Abstract
RATIONALE The proportion of older adults living with long-term conditions (LTCs) is increasing. Self-care and self-management approaches are seen as valuable in helping older people with LTCs to manage their health and care, yet the theoretical overlaps and divergences are not always clear. OBJECTIVES The objectives of this review were to: (1) systematically identify and appraise studies of self-care or self-management of LTCs by community-dwelling older adults (aged ≥60 years) either informed by, applying, creating, or testing theory; (2) explore similarities or points of convergence between the identified theories; and (3) use a meta-ethnographic approach to synthesise the theories and group related concepts into core constructs. METHODS We conducted a systematic theory synthesis, searching six electronic databases. Three reviewers independently screened titles and abstracts followed by full texts and two reviewers appraised study quality. Theoretical data were synthesised within and across individual theories using meta-ethnographic line-of-argument synthesis. RESULTS A total of 141 articles (138 studies) and 76 theories were included in the review. Seven core constructs were developed: (1) temporal and spatial context; (2) stressors; (3) personal resources; (4) informal social resources; (5) formal social resources; (6) behavioural adaptations; and (7) quality of life outcomes. A line of argument was developed that conceptualised older adults' self-care and self-management as a dynamic process of behavioural adaptation, enabled by personal resources and informal and formal social resources, aimed at alleviating the impacts of stressors and maintaining quality of life. CONCLUSION This synthesis provides an overview of theories used in research on older adults' LTC self-care and self-management. Our synthesis describes the complex interplay of intrinsic and extrinsic factors influencing self-care and self-management behaviours and provides considerations for future research, intervention design, and implementation. The utility of the constructs in research and practice requires further attention and empirical validation.
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Affiliation(s)
- Michael T Lawless
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, 5042, Australia; Caring Futures Institute, Flinders University, Bedford Park, SA, 5042, Australia.
| | - Matthew Tieu
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, 5042, Australia; College of Humanities, Arts, and Social Sciences, Flinders University, Bedford Park, SA, 5042, Australia
| | - Rebecca Feo
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, 5042, Australia; Caring Futures Institute, Flinders University, Bedford Park, SA, 5042, Australia
| | - Alison L Kitson
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, 5042, Australia; Caring Futures Institute, Flinders University, Bedford Park, SA, 5042, Australia
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Dong M, Nie A, Liu C, Zheng J. Psychological resilience of patients with bladder cancer after radical cystectomy and urinary diversion: A cross-sectional study. Psychooncology 2021; 31:21-29. [PMID: 34344061 DOI: 10.1002/pon.5770] [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: 12/02/2020] [Revised: 07/10/2021] [Accepted: 07/13/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The aims of this study were to investigate the current state of psychological resilience and identify its associated factors in bladder cancer (BC) patients undergoing radical cystectomy (RC). METHODS A cross-sectional study, using convenience sampling was conducted among 248 patients recruited from urology department of a tertiary hospital in Shenyang, China. According to the resilience in illness model, participants were invited to finish a questionnaire included demographic and disease-related information, Connor-Davidson Resilience Scale, Mishel Uncertainty in Illness Scale, Medical Coping Modes Questionnaire, Social Support Rating Scale, Family adaptation, partnership, growth, affection, and resolve Index and Herth Hope Index. Multiple regression analysis was conducted to explore the predictors of resilience. RESULTS The average resilience score of 53.45 ± 6.22 among BC patients undergoing RC. Multiple regression showed that the associated factors of resilience of postoperative BC patients were gender (β = -0.142, p = 0.002), living in town (β = -0.103, p = 0.052), living alone (β = 0.118, p = 0.026), almost need to be taken care of (β = 0.094, p = 0.064), illness uncertainty (β = -0.249, p < 0.001), confrontation (β = 0.091, p = 0.077), acceptance-resignation (β = -0.205, p < 0.001), social support (β = 0.122, p = 0.029) and hope (β = 0.350, p < 0.001). These predictors accounted for 56.9% of the total variance in resilience (F = 14.964, p < 0.001). CONCLUSIONS Resilience among BC patients undergoing RC needs to be further improved. Hope was the most important variable influencing resilience in BC patients undergoing RC. In the future, we need to pay more attention to the psychological status of patients and encourage them to face the disease with positive emotion and positive coping style to enhance the hope and resilience of patients, so as to improve the quality of life of patients with BC undergoing RC.
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Affiliation(s)
- Mengyuan Dong
- Department of Urinary Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Anliu Nie
- Department of Emergency, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chunxiang Liu
- Department of Urinary Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jin Zheng
- Department of Urinary Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China
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Choi EH, Kang MJ, Lee HJ, Yun MS. A Latent Class Analysis of Health-Related Quality of Life in Korean Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7874. [PMID: 34360166 PMCID: PMC8345710 DOI: 10.3390/ijerph18157874] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/16/2021] [Accepted: 07/22/2021] [Indexed: 11/16/2022]
Abstract
The present study aimed to confirm latent classes in health-related quality of life (HRQOL) in older adults and investigate the characteristics of participants in each class. It aimed to provide basic data to develop interventions for each quality-of-life class by analysing the predictors of each class. Secondary data from a community health survey in G province since 2019 found a total of 41,872 participants. Of them, 9027 were 65 years or older and residing in G Province in 2019, participated in this study. Mplus 8.5 was used to conduct a latent class analysis of five domains of HRQOL. Four latent classes in the HRQOL of older adults, namely, stable type, physical disability type, emotional disability type, and crisis type were found. Certain variables predicted these classes. Based on the findings of the present study, training on functional mobility and balance to prevent falls in older populations and individualised programmes to promote mental health in them should be provided. Moreover, policies should increase medical accessibility and provide social support for older people with low-incomes. Additionally, since physical, psychological, and social health in older adults are inter-connected, a comprehensive care plan is needed to improve their HRQOL.
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Affiliation(s)
| | - Mi-Jung Kang
- College of Nursing, Eulji University, Uijeongbu-si 11759, Korea; (E.-H.C.); (M.-S.Y.)
| | - Hyun-Jin Lee
- College of Nursing, Eulji University, Uijeongbu-si 11759, Korea; (E.-H.C.); (M.-S.Y.)
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Fuller K, Gravlee CC, McCarty C, Mitchell MM, Mulligan CJ. Stressful social environment and financial strain drive depressive symptoms, and reveal the effects of a FKBP5 variant and male sex, in African Americans living in Tallahassee. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2021; 176:572-583. [PMID: 34250587 DOI: 10.1002/ajpa.24362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 05/07/2021] [Accepted: 06/08/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The World Health Organization estimates that almost 300 million people suffer from depression worldwide. African Americans are understudied for depression-related phenotypes despite widespread racial disparities. In our study of African Americans, we integrated information on psychosocial stressors with genetic variation in order to better understand how these factors associated with depressive symptoms. METHODS Our research strategy combined information on financial strain and social networks with genetic data to investigate variation in symptoms of depression (CES-D scores). We collected self-report data on depressive symptoms, financial strain (difficulty paying bills) and personal social networks (a model of an individual's social environment), and we genotyped genetic variants in five genes previously implicated in depressive disorders (HTR1a, BDNF, GNB3, SLC6A4, and FKBP5) in 128 African Americans residing in Tallahassee, Florida. We tested for direct and gene-environment interactive effects of the psychosocial stressors and genetic variants on depressive symptoms. RESULTS Significant associations were identified between high CES-D scores and a stressful social environment (i.e., a high percentage of people in participants' social network who were a source of stress) and high financial strain. Only one genetic variant (rs1360780 in FKBP5) was significantly associated with CES-D scores and only when psychosocial stressors were included in the model; the T allele had an additive effect on depressive symptoms. Sex was also significantly associated with CES-D score in the model with psychosocial stressors and genetic variants; males had higher CES-D scores. No significant interactive effects were detected. CONCLUSIONS A stressful social environment and material disadvantage increase depressive symptoms in the study population. Additional associations with FKBP5 and male sex were revealed in models that included both psychosocial and genetic data. Our results suggest that incorporating psychosocial stressors may empower future genetic association studies and help clarify the biological consequences of social and financial stress.
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Affiliation(s)
- Kia Fuller
- Department of Anthropology, University of Florida, Gainesville, Florida, USA.,University of Florida Genetics Institute, University of Florida, Gainesville, Florida, USA
| | - Clarence C Gravlee
- Department of Anthropology, University of Florida, Gainesville, Florida, USA.,University of Florida Genetics Institute, University of Florida, Gainesville, Florida, USA.,Health Equity Alliance of Tallahassee (HEAT), Tallahassee, Florida, USA
| | - Christopher McCarty
- Department of Anthropology, University of Florida, Gainesville, Florida, USA.,Bureau of Economic and Business Research, University of Florida, Gainesville, Florida, USA
| | - Miaisha M Mitchell
- Health Equity Alliance of Tallahassee (HEAT), Tallahassee, Florida, USA.,Greater Frenchtown Revitalization Council, Tallahassee, Florida, USA
| | - Connie J Mulligan
- Department of Anthropology, University of Florida, Gainesville, Florida, USA.,University of Florida Genetics Institute, University of Florida, Gainesville, Florida, USA
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Identifying relevant factors for successful implementation into routine practice: expert interviews to inform a heart failure self-care intervention (ACHIEVE study). BMC Health Serv Res 2021; 21:585. [PMID: 34140007 PMCID: PMC8211453 DOI: 10.1186/s12913-021-06596-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/31/2021] [Indexed: 11/11/2022] Open
Abstract
Background Adherence to heart failure (HF) self-care behaviours has been found to be effective for alleviating illness symptoms, increasing quality of life and reducing hospital re-admissions and mortality. However, many patients fail to implement on-going self-care into their daily lives. It is therefore crucial to improve the behaviour of HF patients to increase self-care adherence. The aim of this study is to identify relevant factors to successfully implement a complex, theory-based HF self-care intervention into routine practice. Methods We conducted semi-structured interviews to obtain key stakeholders’ opinions on previously developed behaviour change techniques for enhancing HF patients’ self-care behaviours, in order to optimise implementation of these techniques in an intervention. The interview topic guide was developed based on the Normalisation Process Theory (NPT), a tool that takes into account the feasibility of implementation and the acceptability to stakeholders. Interviews were analysed using thematic analysis and supported by MAXQDA 2020, a software for qualitative research. Results Interview participants included 18 key stakeholders consisting of three crucial groups: clinical experts (n = 7), patients (n = 3) and high calibre policy makers/potential funders (n = 8). The interviews revealed numerous factors to consider for successful implementation of an intervention into routine practice. The findings are presented according to two major categories: (1) themes within the NPT framework and (2) themes beyond the NPT framework. Themes within the NPT component ‘Coherence’ include three sub-themes: ‘understandability’, ‘value beyond existing interventions’ and ‘perceived benefits’. The NPT component ‘Cognitive participation’ revealed two sub-themes: ‘time resources’ and ‘financial sustainability’. Finally, the NPT component ‘Collective action’ uncovered three sub-themes: ‘need for training’, ‘compatibility with existing practice’ and ‘influence on roles’. A further two themes were identified beyond the NPT framework, namely: ‘structural challenges’ and (2) ‘role of carers’. Conclusions Factors identified previously by NPT were validated, but stakeholders further identified relevant aspects beyond NPT. Based on these findings, we suggest the existing NPT framework could be expanded to include a fifth component: questions considering specific environmental factors (contextual considerations). Sensitising researchers to these issues at an early stage when designing an intervention can facilitate its later success. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06596-w.
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Zippel-Schultz B, Palant A, Eurlings C, F Ski C, Hill L, Thompson DR, Fitzsimons D, Dixon LJ, Brandts J, Schuett KA, de Maesschalck L, Barrett M, Furtado da Luz E, Hoedemakers T, Helms TM, Brunner-La Rocca HP. Determinants of acceptance of patients with heart failure and their informal caregivers regarding an interactive decision-making system: a qualitative study. BMJ Open 2021; 11:e046160. [PMID: 34135043 PMCID: PMC8211061 DOI: 10.1136/bmjopen-2020-046160] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Heart failure is a growing challenge to healthcare systems worldwide. Technological solutions have the potential to improve the health of patients and help to reduce costs. Acceptability is a prerequisite for the use and a successful implementation of new disruptive technologies. This qualitative study aimed to explore determinants that influence the acceptance of patients and their informal caregivers regarding a patient-oriented digital decision-making solution-a doctor-at-home system. DESIGN We applied a semistructured design using an interview guide that was based on a theoretical framework influenced by established acceptance theories. The interviews were analysed using a content analysis. SETTING A multicentred study in four European countries. PARTICIPANTS We interviewed 49 patients and 33 of their informal caregivers. Most of the patients were male (76%) and aged between 60 and 69 years (43%). Informal caregivers were mostly female (85%). The majority of patients (55%) suffered from heart failure with mild symptoms. RESULTS Four main categories emerged from the data: needs and expectations, preferences regarding the care process, perceived risk and trust. Participants expressed clear wishes and expectations regarding a doctor-at-home, especially the need for reassurance and support in the management of heart failure. They were receptive to changes to the current healthcare processes. However, trust was identified as an important basis for acceptance and use. Finally, perceived risk for decision-making errors is a crucial topic in need of attention. CONCLUSION Patients and informal caregivers see clear benefits of digitalisation in healthcare. They perceive that an interactive decision-making system for patients could empower and enable effective self-care. Our results provide important insights for development processes of patient-centred decision-making systems by identifying facilitators and barriers for acceptance. Further research is needed, especially regarding the influence and mitigation of patients and informal caregivers' perceived risks.
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Affiliation(s)
| | | | - Casper Eurlings
- Cardiology Department, Laurentius Hospital, Roermond, The Netherlands
| | - Chantal F Ski
- Integrated Care Academy, University of Suffolk, Ipswich, UK
| | - Loreena Hill
- School of Nursing and Midwifery, Queen's University, Belfast, UK
| | - David R Thompson
- School of Nursing and Midwifery, Queen's University, Belfast, UK
| | - Donna Fitzsimons
- School of Nursing and Midwifery, Queen's University, Belfast, UK
| | - Lana J Dixon
- Belfast Health and Social Care Trust, Belfast, UK
| | - Julia Brandts
- Department of Cardiology, University Hospital Aachen, Aachen, Germany
| | | | | | - Matthew Barrett
- Catherine McAuley Education and Research Centre, University College of Dublin, Dublin, Ireland
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20
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The Relationship Between Uncertainty in Illness and Quality of Life in Patients With Heart Failure: Multiple Mediating Effects of Perceived Stress and Coping Strategies. J Cardiovasc Nurs 2021; 37:257-265. [PMID: 33764941 DOI: 10.1097/jcn.0000000000000799] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Previous investigators have demonstrated that uncertainty in illness is associated with quality of life (QoL) in patients with chronic illness. However, little is known about the mechanism underlying the relationship in patients with heart failure. OBJECTIVE The aim of this study was to examine the multiple mediating effects of perceived stress and coping strategies on the relationship between uncertainty in illness and QoL in patients with heart failure. METHODS We conducted a cross-sectional study in 302 patients with heart failure recruited at a general hospital in China from October 2016 to September 2017. Uncertainty in illness, perceived stress, coping strategies, and QoL were assessed using self-reported questionnaires. The multiple mediation model was tested using the PROCESS macro for SPSS. RESULTS Of the 302 patients, 51.7% had poor physical QoL and 45.7% had poor mental QoL (physical component summary or mental component summary score of <50 points). Uncertainty in illness had a significantly negative indirect effect on mental QoL through perceived stress and acceptance-resignation (indirect effect, -0.02; 95% confidence interval, -0.04 to -0.01). Uncertainty in illness also had a significantly negative indirect effect on mental QoL via perceived stress only (indirect effect, -0.18; 95% confidence interval, -0.26 to -0.09). CONCLUSIONS Poor QoL is prevalent in patients with heart failure. Perceived stress and acceptance-resignation are important mediating factors between uncertainty in illness and mental QoL in patients with heart failure. Interventions aimed at reducing perceived stress and acceptance-resignation coping may be beneficial for improving mental QoL in patients with heart failure.
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21
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Connolly T, Coats H, DeSanto K, Jones J. The experience of uncertainty for patients, families and healthcare providers in post-stroke palliative and end-of-life care: a qualitative meta-synthesis. Age Ageing 2021; 50:534-545. [PMID: 33206952 DOI: 10.1093/ageing/afaa229] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Indexed: 01/14/2023] Open
Abstract
PURPOSE recent data show that there is limited evidence and guidance regarding the best practices for the integration of palliative care (PC) and end-of-life (EOL) post-stroke. The purpose of this meta-synthesis is to understand the PC/EOL experiences after a stroke. METHODS a meta-synthesis was conducted to answer the following research question-What are post-stroke PC/EOL experiences from the perspectives of patients, families and healthcare professionals (HCPs)? This approach was completed through two main phases-a systematic search and appraisal of the literature and reciprocal translation with interpretive triangulation of the extracted data. Databases searched were MEDLINE, EMBASE, PsycINFO, Joanna Briggs Institute and CINAHL databases (from their inception to April 2020). After data were extracted, a qualitative exploratory design was used to evaluate the PC/EOL in post-stroke experiences. RESULTS the search identified 696 studies. A total of 14 studies were included in this meta-synthesis as they satisfied our eligibility criteria. Uncertainty post-stroke was the overarching main theme that emerged across post-stroke PC/EOL experiences. Within this theme of uncertainty, opportunities to decrease uncertainty emerged from two interdependent themes-presence of cohesive communication and shared dynamic decision process for both families and HCPs. CONCLUSIONS to mitigate the degree of uncertainty post-stroke, HCPs should be present, provide clear direct communication and incorporate the value-based goals of care within their medical treatment plan. These findings suggest that future research is needed to focus on how PC approaches can be integrated into stroke care programmes.
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Affiliation(s)
- Teresa Connolly
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Heather Coats
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kristen DeSanto
- Strauss Health Sciences Library, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jacqueline Jones
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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22
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Salzmann S, Euteneuer F, Laferton JAC, Shedden-Mora MC, Schedlowski M, Moosdorf R, Rief W. IL-8 and CRP moderate the effects of preoperative psychological interventions on postoperative long-term outcomes 6 months after CABG surgery - The randomized controlled PSY-HEART trial. Brain Behav Immun 2021; 91:202-211. [PMID: 33002633 DOI: 10.1016/j.bbi.2020.09.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 08/24/2020] [Accepted: 09/23/2020] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Inflammation has been related to several somatic and psychological disorders and may moderate effects of psychological interventions. In the PSY-HEART trial patients benefitted from preoperative psychological interventions before undergoing coronary artery bypass graft surgery (CABG) and, if necessary, concomitant valvular surgery, compared to standard medical care. In this study we examined whether patients' baseline inflammatory status moderated the intervention effects. MATERIAL AND METHODS In a prospective three-arm randomized clinical trial with 6-months follow-up, 124 patients scheduled for CABG surgery alone or concomitant with valvular surgery were randomized to (i) standard medical care only (SMC) or two preoperative psychological interventions: (ii) CBT-based optimizing expectations (EXPECT) and an (iii) an active control group focusing on emotional support (SUPPORT). Available baseline CRP- (n = 79), IL-6- (n = 78), IL-8- (n = 78) and TNF-alpha-(n = 80) parameters were considered as potential moderators (CRP as a categorical and continuous moderator). Linear mixed model analyses were calculated to test whether baseline inflammatory levels moderated intervention effects on disability, mental and physical quality of life at 6 months after surgery. RESULTS IL-8 moderated intervention effects on patients' disability and categorical CRP moderated intervention effects on mental quality of life. Follow-up tests indicated that EXPECT (and in part SUPPORT) led to lower postoperative disability and higher mental quality of life compared to SMC in patients with low baseline inflammatory markers. EXPECT indicated higher mental quality of life compared to SUPPORT in the high CRP subgroup. Patients in the SMC group had higher mental quality of life in the high CRP subgroup compared to the low CRP subgroup. CONCLUSION Especially for patients with a lower inflammatory baseline status preoperative psychological interventions might be helpful to optimize long-term CABG surgery outcomes.
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Affiliation(s)
- Stefan Salzmann
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany.
| | - Frank Euteneuer
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany; Clinical Psychology and Psychotherapy, Medical School Berlin, Berlin, Germany
| | - Johannes A C Laferton
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany; Department of Clinical Psychology and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany
| | - Meike C Shedden-Mora
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Manfred Schedlowski
- Institute of Medical Psychology and Behavioral Immunobiology, University Clinic Essen, Essen, Germany; Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institute, 17177 Stockholm, Sweden
| | - Rainer Moosdorf
- Department for Cardiovascular Surgery, Heart Center, Philipps University of Marburg, Marburg, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany
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Shabu S, Jayasekara R. Effectiveness of cognitive behavior therapy for patients with heart failure and depression: A systematic review protocol. Nurs Health Sci 2020; 22:14-19. [PMID: 31499596 DOI: 10.1111/nhs.12646] [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] [Received: 07/10/2018] [Revised: 08/08/2019] [Accepted: 08/11/2019] [Indexed: 08/31/2023]
Abstract
The objective of this review is to determine the effectiveness of cognitive behavior therapy for patients with heart failure and depression, aged ≥18 years, in institutionalized healthcare settings. More specifically, the review aims to identify which cognitive behavior therapy strategy/strategies, including the method of delivery, is the most effective for the management of depression in hospitalized patients with heart failure. The review question is as follows: Is cognitive behavior therapy effective in reducing symptoms of depression in patients with heart failure? This systematic review will be conducted in accordance with the Joanna Briggs Institute methodology for systematic reviews of effectiveness evidence. This review only includes randomized controlled trials assessing the effectiveness of cognitive behavior therapy as a treatment for depression in adults (aged ≥18 years) with heart failure, compared with usual care, which might include medications.
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Affiliation(s)
- Shancy Shabu
- Cardiac Step Down Ward, The Queen Elizabeth Hospital, Adelaid, South Australia, Australia
- School of Nursing and Midwifery, University of South Australia, Adelaide, South Australia, Australia
| | - Rasika Jayasekara
- School of Nursing and Midwifery, University of South Australia, Adelaide, South Australia, Australia
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The impacts of resilience on the association between illness uncertainty and sleep quality among Chinese women with systemic lupus erythematosus. Clin Rheumatol 2020; 39:1609-1616. [PMID: 31897957 DOI: 10.1007/s10067-019-04898-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 11/13/2019] [Accepted: 12/14/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Our study aimed to investigate the effect of illness uncertainty on sleep quality among SLE women. Meanwhile, the role of resilience was explored in the association of illness uncertainty with sleep quality. METHODS This cross-sectional study was carried out from 2017 to 2018 in Liaoning province, China. Totally, 204 (81.6%) completed questionnaires concerning Pittsburgh Sleep Quality Index (PSQI), Mishel Uncertainty in Illness Scale for Adults (MUIS-A), Connor-Davidson Resilience Scale (CD-RISR), demographic, and clinical characteristics were collected. Multiple hierarchical regression analysis was used to test the associations of illness uncertainty, resilience, and the illness uncertainty*resilience interaction with sleep quality. The mediating role of resilience was explored by applying asymptotic and resampling strategies. RESULTS The mean of PSQI score was 10.71 ± 3.68. Illness uncertainty was negatively related to sleep quality. The illness uncertainty*resilience interaction term was significantly associated with sleep quality. The effect of illness uncertainty on sleep quality was gradually weaken from low (1 SD below the mean, β = 0.151, P < 0.001), mean (β = 0.294, P < 0.001), to high (1 SD above the mean, β = 0.437, P < 0.001) levels of resilience. Meanwhile, resilience partially mediated the association of illness uncertainty with sleep quality (a*b = 0.2383, BCa 95% CI: 0.1021, 0.3842). CONCLUSIONS Poor sleep quality was the most frequent among SLE women. Illness uncertainty and resilience may be related factors associated with sleep quality. Thus, in practice, more targeted information support should be offered to increase illness perception. Moreover, more targeted psychological interventions based on resilience should be provided to enhance resilience in order to improve sleep qualityKey Points• Illness uncertainty may be related factor associated with sleep quality and negatively affected sleep quality among women with systemic lupus erythematosus (SLE).• Resilience acted as a moderator in the relationship between illness uncertainty and sleep quality among women with SLE. Meanwhile, resilience partially mediated the association of illness uncertainty with sleep quality.• More targeted information supports and psychological interventions based on resilience should be provided to enhance illness perception and resilience in order to improve sleep quality.
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Daley C, Cornet V, Patekar G, Kosarabe S, Bolchini D, Toscos T, Mirro M, Wagner S, Martin E, Ghahari RR, Ahmed R, Miller A, Holden RJ. Uncertainty Management Among Older Adults with Heart Failure: Responses to Receiving Implanted Device Data using a Fictitious Scenario Interview Method. ACTA ACUST UNITED AC 2019. [DOI: 10.1177/2327857919081030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Heart failure (HF) is a complex chronic illness that affects the older adult population, requiring medical therapy and day-to-day management to prevent worsening and exacerbation. Patients with HF are often treated with cardiac implanted electronic devices (CIEDs) which capture diagnostic and predictive parameters for HF. In this work we explore how patients would respond to receiving data from an implanted device, using a fictitious scenario interview method with 24 older adults with HF. We applied an uncertainty management lens to better understand how patients face uncertain outcomes and integrate novel data into their decision making. The findings provide insight into how patients would engage and respond to a technology which provides an indicator of their HF status from an implanted device.
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Affiliation(s)
- Carly Daley
- Department of BioHealth Informatics, IUPUI, Indianapolis, IN, USA
- Parkview Mirro Center for Research and Innovation, Parkview Health, Fort Wayne, IN, USA
| | - Victor Cornet
- Department of Human-Centered Computing, IUPUI, Indianapolis, IN, USA
| | - Gauri Patekar
- Department of Human-Centered Computing, IUPUI, Indianapolis, IN, USA
| | - Swapnil Kosarabe
- Department of Human-Centered Computing, IUPUI, Indianapolis, IN, USA
| | - Davide Bolchini
- Department of Human-Centered Computing, IUPUI, Indianapolis, IN, USA
| | - Tammy Toscos
- Department of BioHealth Informatics, IUPUI, Indianapolis, IN, USA
- Parkview Mirro Center for Research and Innovation, Parkview Health, Fort Wayne, IN, USA
| | - Michael Mirro
- Department of BioHealth Informatics, IUPUI, Indianapolis, IN, USA
- Parkview Mirro Center for Research and Innovation, Parkview Health, Fort Wayne, IN, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Shauna Wagner
- Parkview Mirro Center for Research and Innovation, Parkview Health, Fort Wayne, IN, USA
| | - Elizabeth Martin
- Parkview Mirro Center for Research and Innovation, Parkview Health, Fort Wayne, IN, USA
| | - Romisa Rohani Ghahari
- Parkview Mirro Center for Research and Innovation, Parkview Health, Fort Wayne, IN, USA
| | - Ryan Ahmed
- Parkview Mirro Center for Research and Innovation, Parkview Health, Fort Wayne, IN, USA
| | - Amy Miller
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Richard J. Holden
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Regenstrief Institute, Indianapolis, IN, USA
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26
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Nielsen C, Ratiu I, Esfandiarei M, Chen A, Selamet Tierney ES. A Review of Psychosocial Factors of Marfan Syndrome: Adolescents, Adults, Families, and Providers. J Pediatr Genet 2019; 8:109-122. [PMID: 31406616 DOI: 10.1055/s-0039-1693663] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 06/12/2019] [Indexed: 02/07/2023]
Abstract
The purpose of this article was to review the current literature on psychosocial implications of Marfan syndrome (MFS) and its impact on adolescents, adults, their families and to provide important considerations for providers. Since the previous reviews in 2015, numerous studies have been published that are included in the current review. This literature review was conducted using PubMed, Medline, PsychINFO, ERIC, Web of Science, and Academic Search Premier databases and only articles that studied psychosocial factors that influence MFS patients as adolescents, adults, family members, or their interactions with providers were included in this review. Of the 522 articles reviewed, 41 were selected based on the inclusion and exclusion criteria. All articles were peer-reviewed. MFS has various implications that can impact one's life; studies have shown that MFS causes a negative impact on an individual's formative years, quality of life, reproductive decision-making, work participation, and satisfaction with life. Clinicians and multidisciplinary teams should be aware of these factors to provide support focusing on coping strategies for the patient and their family.
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Affiliation(s)
- Cory Nielsen
- Biomedical Sciences Program, College of Graduate Studies, Midwestern University, Glendale, Arizona, United States
| | - Ileana Ratiu
- Speech-Language Pathology Program, College of Health Sciences, Midwestern University, Glendale, Arizona, United States
| | - Mitra Esfandiarei
- Biomedical Sciences Program, College of Graduate Studies, Midwestern University, Glendale, Arizona, United States
| | - Angela Chen
- Department of Pediatric Cardiology, Stanford University, Palo Alto, California, United States
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Correction: Uncertainty and depressive symptoms as mediators of quality of life in patients with heart failure. PLoS One 2019; 14:e0214825. [PMID: 30921427 PMCID: PMC6438470 DOI: 10.1371/journal.pone.0214825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0205953.].
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