Support that considers the experiences, perspectives and behaviours of heart failuare patients helps increase effective self-care

Spaling MA, Currie K, Strachan PH, et al.  Improving support for heart failure patients: A systematic review to understand patients' perspectives on self-care  Journal of Advanced Nursing. 2015 November:71(11):2478-89

Review question

Do strategies and interventions that incorporate heart failure patients’ experiences, perspectives and behaviours improve their willingness and capacity to self-care effectively?

Background

Despite increased recognition of the importance of self-care among adult heart failure patients, the knowledge and practices around it and interventions to improve it are inconsistent.

Currently, guidelines recommend that all patients with heart failure receive education and support regarding heart failure and self-care. There is acknowledgement that such self-care might be influenced by factors other than information, however this has not received much attention.

It may be important to consider bridging conceptual and actual self-care practices, and to offer multiple, specific recommendations to improve patients’ willingness and capacity to effectively take care of themselves.

How the review was done

A detailed search of a number of electronic databases for studies published up until May 2010 was conducted. Studies that focused on themes pertaining to self-care among patients with heart failure and that contained data on adult patients’ self-care, were included in the review.

A total of 1,421 studies were identified in searches and 37 were included in the review after assessments for eligibility.

This review was funded by a Canadian Institutes of Health Research (CIHR) Knowledge Synthesis Grant.

What the researchers found

It was found that merely providing patients with more sophisticated knowledge of heart failure is unlikely to improve their self-care. Patients often report an inability to apply this knowledge in their day-to-day lives, and would benefit from conceptual knowledge being linked to personal experiences.

Further, despite being provided knowledge, patients’ understanding of the domains of self-care following heart failure remains low, particularly with respect to medication, diet, fluid management and timeliness of seeking help.

Decision aids could be utilized to navigate key stages in the decision-making process, and should be co-developed with patients to prioritize their personal experiences and values regarding effectively managing their condition.

Conclusion

The review found that healthcare professionals should harness patients’ experiences with managing heart failure and foster a sense of control and self-efficacy. Currently, although patients receive information at times, their overall knowledge about and willingness to provide their own care is low. Future studies should explore complex patient-centred approaches to supporting effective self-care following heart failure, and move away from being purely knowledge-based.

This summary is based on a review that was determined to be of medium methodological quality based on an assessment using the AMSTAR tool.