Patient-centred approaches may be beneficial in the provision of care for chronic heart failure patients

Kane PM, Murtagh FE, Ryan K, et al.  The gap between policy and practice: A systematic review of patient-centred care interventions in chronic heart failure Heart Failure Reviews. 2015 October:20(6):673-687.

Review question

Can patient-centred care be used to inform treatment decisions for chronic heart failure patients in order to improve care?

Background

Patients with chronic heart failure experience considerable illness burden, reduced quality of life and high levels of uncertainty with respect to their future health status.

Treatment decisions for chronic heart failure are challenging for both patients and healthcare providers due to an increase in the number of available treatment options, patients’ lack of understanding of their likely health outcomes, and challenges understanding the detrimental effects the treatment can have on quality of life.

Patient-centred care may be a promising means to encourage patient involvement and incorporate their preferences, values, beliefs, illness understanding and experience into the decision-making process; however, there has been no systematic effort examining the evidence.

How the review was done

A detailed search of a number of electronic databases for studies published up to March 2015 was conducted. Studies that focused on patient empowerment, self-care and shared decision-making were included.

A total of 13,944 studies were identified in searches, and 15 studies were included in the review after assessments for eligibility.

This review was funded by BuildCARE, the National Institute for Health Research, and the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Funding. 

What the researchers found

The approaches to patient-centred care identified in the studies included patient assessment, education of healthcare professionals and patients, and healthcare professional-patient collaboration.

The review found low- and moderate-quality evidence that patient-centred care improves health-related quality of life, symptom burden, depression and patient engagement.

There is a gap between policy recommendations for patient-centred care and actual clinical practice given there is no agreed-upon definition of patient-centred care, and typical indicators used for measuring the quality of care in chronic heart failure (i.e. discharge instructions, medication use and smoking cessation) do not encompass components relevant to patient-centred care.

Conclusion

Patient-centred care may be beneficial in treating patients with chronic heart failure, but high-quality evidence is needed to establish a strong relationship between specific aspects of patient-centred care and better care outcomes.