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2.
Int J Stroke ; : 17474930211022678, 2021 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-34037468

RESUMO

RATIONALE: To address unmet needs, electronic messages to support person-centered goal attainment and secondary prevention may avoid hospital presentations/readmissions after stroke, but evidence is limited. HYPOTHESIS: Compared to control participants, there will be a 10% lower proportion of intervention participants who represent to hospital (emergency/admission) within 90 days of randomization. METHODS AND DESIGN: Multicenter, double-blind, randomized controlled trial with intention-to-treat analysis. The intervention group receives 12 weeks of personalized, goal-centered, and administrative electronic messages, while the control group only receive administrative messages. The trial includes a process evaluation, assessment of treatment fidelity, and an economic evaluation. Participants: Confirmed stroke (modified Rankin Score: 0-4), aged ≥18 years with internet/mobile phone access, discharged directly home from hospital. Randomization: 1:1 computer-generated, stratified by age and baseline disability. Outcomes assessments: Collected at 90 days and 12 months following randomization. OUTCOMES: Primary outcomes include hospital emergency presentations/admissions within 90 days of randomization. Secondary outcomes include goal attainment, self-efficacy, mood, unmet needs, disability, quality-of-life, recurrent stroke/cardiovascular events/deaths at 90 days and 12 months, and death and cost-effectiveness at 12 months. Sample size: To test our primary hypothesis, we estimated a sample size of 890 participants (445 per group) with 80% power and two-tailed significance threshold of α = 0.05. Given uncertainty for the effect size of this novel intervention, the sample size will be adaptively re-estimated when outcomes for n = 668 are obtained, with maximum sample capped at 1100. DISCUSSION: We will provide new evidence on the potential effectiveness, implementation, and cost-effectiveness of a tailored eHealth intervention for survivors of stroke.

3.
Pilot Feasibility Stud ; 6(1): 172, 2020 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-33292693

RESUMO

BACKGROUND: Electronic communication is used in various populations to achieve health goals, but evidence in stroke is lacking. We pilot tested the feasibility and potential effectiveness of a novel personalised electronic self-management intervention to support person-centred goal attainment and secondary prevention after stroke. METHODS: A phase I, prospective, randomised controlled pilot trial (1:1 allocation) with assessor blinding, intention-to-treat analysis, and a process evaluation. Community-based survivors of stroke were recruited from participants in the Australian Stroke Clinical Registry (AuSCR) who had indicated their willingness to be contacted for research studies. Inclusion criteria include 1-2 years following hospital admission for stroke and living within 50 km of Monash University (Melbourne). Person-centred goals were set with facilitation by a clinician using a standardised template. The intervention group received electronic support messages aligned to their goals over 4 weeks. The control group received only 2-3 electronic administrative messages. Primary outcomes were study retention, goal attainment (assessed using Goal Attainment Scaling method) and satisfaction. Secondary outcomes were self-management (Health Education Impact Questionnaire: 8 domains), quality of life, mood and acceptability. RESULTS: Of 340 invitations sent from AuSCR, 73 responded, 68 were eligible and 57 (84%) completed the baseline assessment. At the goal-setting stage, 54/68 (79%) were randomised (median 16 months after stroke): 25 to intervention (median age 69 years; 40% female) and 29 to control (median age 68 years; 38% female). Forty-five (83%) participants completed the outcome follow-up assessment. At follow-up, goal attainment (mean GAS-T score ≥ 50) in the intervention group was achieved for goals related to function, participation and environment (control: environment only). Most intervention participants provided positive feedback and reported that the iVERVE messages were easy to understand (92%) and assisted them in achieving their goals (77%). We found preliminary evidence of non-significant improvements between the groups for most self-management domains (e.g. social integration and support: ß coefficient 0.34; 95% CI - 0.14 to 0.83) and several quality-of-life domains in favour of the intervention group. CONCLUSION: These findings support the need for further randomised effectiveness trials of the iVERVE program to be tested in people with new stroke. TRIAL REGISTRATION: ANZCTR, ACTRN12618001519246 . Registered on 11 September 2018-retrospectively registered.

4.
Psychol Health Med ; : 1-9, 2020 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-33382635

RESUMO

Cognitive deficits are common in patients with chronic heart failure (HF), but little attention has been given to the investigation of prospective memory (PM) - the ability to execute delayed intentions. Importantly, many aspects of PM are crucial for patient implementation of HF self-care behaviours. Here we provide a replication of our original work involving PM in patients with HF. We compared a group of 51 HF patients to 41 closely matched controls. The primary outcome measure was a laboratory test of PM, Virtual week, which closely simulates PM tasks in daily life. A series of background cognitive tests were also administered. Consistent with our previous work, the HF group had significant PM impairment compared to controls, and these difficulties were generalised across different types of PM tasks. Surprisingly, we did not find any differences in the background cognitive tasks between groups. Compared to controls, the HF group had significant and similar sized deficits on all task parameters assessed (event, time, regular, irregular) of PM function, which likely impacts engagement in HF self-care.

6.
Top Stroke Rehabil ; 27(8): 563-576, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32191569

RESUMO

Background and Purpose: Stroke can have a devastating impact on the mental and physical health of stroke survivors and their carers. We aimed to evaluate the effectiveness of a novel psychosocial intervention designed to improve health outcomes in both groups.Methods: We conducted a randomized controlled trial of a personalized psychosocial intervention (eight 1-hour weekly sessions plus one booster) compared to usual care for adult stroke survivors and carers. Participants recruited from hospital services and community referrals completed questionnaires at baseline, 3, 6, and 12 months. Primary outcomes were quality of life and self-efficacy; secondary outcomes were depressive and anxiety symptoms, coping, illness perception, work and social adjustment, carer strain, and carer satisfaction. Mixed-effect model repeated measures analysis between groups and across time was conducted.Results: Of the 173 participants recruited (89 stroke survivors; 84 carers), a total of 137 participants - 73 stroke survivors (intervention n = 42; usual care n = 31) and 64 carers (intervention n = 35; usual care n = 29) - underwent analysis up to 12 months. No statistically significant differences were found in the primary outcomes between groups over time, though a significant improvement in carer satisfaction was found at 6 months in the intervention group compared to the usual care group.Conclusion: A personalized psychosocial intervention resulted in a significant improvement in carer satisfaction at 6 months but in no other outcomes. A lack of available services and barriers to social engagement may have impeded the effectiveness of this intervention.


Assuntos
Cuidadores , Acidente Vascular Cerebral , Adulto , Humanos , Intervenção Psicossocial , Qualidade de Vida , Acidente Vascular Cerebral/terapia , Sobreviventes
7.
BMJ Open ; 9(8): e025525, 2019 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-31462460

RESUMO

OBJECTIVE: To identify differences in psychosocial, behavioural and clinical outcomes between patients with heart failure (HF) with and without stroke. DESIGN AND PARTICIPANTS: A secondary analysis of 1023 patients with heart failure enrolled in the Coordinating study evaluating Outcomes of Advising and Counselling in Heart failure. SETTING: Seventeen hospitals located across the Netherlands. OUTCOMES MEASURES: Depressive symptoms (Centre for Epidemiological Studies Depression Scale), quality of life (Minnesota Living with Heart Failure Questionnaire, Ladder of Life Scale), self-care (European Heart Failure Self-Care Behaviour Scale), adherence to HF management (modified version of the Heart Failure Compliance Questionnaire) and readmission for HF, cardiovascular-cause and all-cause hospitalisations at 18 months, and all-cause mortality at 18 months and 3 years. RESULTS: Compared with those without stroke, patients with HF with a stroke (10.3%; n=105) had twice the likelihood of severe depressive symptoms (OR 2.83, 95% CI 1.27 to 6.28, p=0.011; OR 2.24, 95% CI 1.03 to 4.88, p=0.043) at 12 and 18 months, poorer disease-specific and generic quality of life (OR 2.80, 95% CI 1.61 to 4.84, p<0.001; OR 2.00, 95% CI 1.09 to 3.50, p=0.019) at 12 months, poorer self-care (OR 1.80, 95% CI 1.05 to 3.11, p=0.034; OR 2.87, 95% CI 1.61 to 5.11, p<0.0011) and HF management adherence (OR 0.39, 95% CI 0.18 to 0.81, p=0.012; OR 0.35, 95% CI 0.17 to 0.72, p=0.004) at 12 and 18 months, higher rates of hospitalisations and mortality at 18 months and higher all-cause mortality (HR 1.43, 95% CI 1.07 to 1.91, p=0.016) at 3 years. CONCLUSIONS: Patients with HF and stroke have worse psychosocial, behavioural and clinical outcomes, notably from 12 months, than those without stroke. To ameliorate these poor outcomes long-term, integrated disease management pathways are warranted.


Assuntos
Insuficiência Cardíaca/psicologia , Acidente Vascular Cerebral/psicologia , Idoso , Idoso de 80 Anos ou mais , Depressão/epidemiologia , Depressão/etiologia , Feminino , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Cooperação do Paciente , Escalas de Graduação Psiquiátrica , Psicologia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/terapia , Inquéritos e Questionários , Resultado do Tratamento
8.
Top Stroke Rehabil ; 26(7): 554-564, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31258017

RESUMO

Objective: To evaluate the effectiveness of psychosocial interventions on depressive symptoms, anxiety symptoms, quality of life, self-efficacy, coping, carer strain and carer satisfaction among stroke survivors, carers and survivor-carer dyads. Data sources: MEDLINE, CINAHL, PsycINFO, SocINDEX, Cochrane Library, Web of Science and Scopus databases and the grey literature were searched up to September 2018. Methods: A systematic review and meta-analysis of randomized controlled trials of psychosocial interventions for stroke survivors, carers and survivor-carer dyads, compared to usual care. Outcomes measured were depressive symptoms, anxiety symptoms, quality of life, coping, self-efficacy, carer strain, and carer satisfaction. Results: Thirty-one randomized controlled trials (n = 5715) were included in the systematic review which found improvements in depressive symptoms, anxiety symptoms, quality of life and coping, though the number of trials assessing each outcome varied. A meta-analysis (11 trials; n = 1280) on depressive symptoms found that in seven trials psychosocial interventions reduced depressive symptoms in stroke survivors (SMD: -0.36, 95% CI -0.73 to 0.00; p = .05) and in six trials reduced depressive symptoms in carers (SMD: -0.20, 95% CI -.40 to 0.00; p = .05). Conclusion: Psychosocial interventions reduced depressive symptoms in stroke survivors and their carers. There was limited evidence that such interventions reduced anxiety symptoms, or improved quality of life and coping for stroke survivors and carers and no evidence that they improved self-efficacy, carer strain or carer satisfaction.


Assuntos
Cuidadores/psicologia , Psicoterapia/métodos , Apoio Social , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/psicologia , Depressão , Humanos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Reabilitação do Acidente Vascular Cerebral/psicologia , Sobreviventes
9.
Heart Lung ; 48(4): 313-319, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31076180

RESUMO

BACKGROUND: Recent guidelines highlight the need for clinician-patient discussions regarding end-of-life (EOL) choices prior to implantable cardioverter defibrillator (ICD) implantation. Health literacy could affect the quality and quantity of such discussions. OBJECTIVE: Our objective was to determine the association of health literacy with experiences, attitudes, and knowledge of the ICD at EOL. METHODS: In this cross-sectional study, we used validated instruments to measure health literacy and patient experiences, attitudes, and knowledge of the ICD at EOL. RESULTS: Of the 240 ICD recipients, 76% of participants reported never having discussed the implications of a future withdrawal of defibrillation therapy with their healthcare provider. Increased odds of choosing to maintain defibrillation therapy were associated with female gender and lower ICD knowledge. CONCLUSIONS: From patients' perspectives, EOL discussions with providers were minimal. Most patients hold misperceptions about ICD function that could interfere with optimal EOL care, particularly for those with inadequate health literacy.


Assuntos
Tomada de Decisões , Desfibriladores Implantáveis , Cardioversão Elétrica/psicologia , Letramento em Saúde/métodos , Pessoal de Saúde/psicologia , Assistência Terminal/métodos , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Suspensão de Tratamento
12.
Aust Crit Care ; 32(5): 383-390, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30292645

RESUMO

BACKGROUND: Perceived control is strongly associated with health-related quality of life (HRQOL) among patients with chronic conditions, and it is possible to increase perceived control with appropriate intervention. Little is known about the relationship between perceived control and HRQOL in implantable cardioverter defibrillator (ICD) recipients. OBJECTIVES: To determine the relationship of perceived control with quality of life in ICD recipients and to determine predictors of perceived control in this population. METHODS: A total of 263 ICD recipients (63% male, age 61 ± 14 years) completed the Control Attitude Scale-Revised to measure perceived control and completed self-reported measures on potential correlates of perceived control (i.e., depressive symptoms, anxiety, social support, and ICD concerns). The EuroQol-5D was used to measure HRQOL. Regression analysis was used to determine predictors of perceived control and its relationship to HRQOL, controlling for covariates. RESULTS: Lower perceived control (ß = 0.30, p < .01), and higher levels of depression (ß = -0.30, p < .01) and anxiety (ß = -0.18, p < .05) predicted lower levels of HRQOL. Higher anxiety (ß = -0.17, p < .05), higher depression (ß = -0.23, p < .05), lower social support (ß = 0.26, p < .01), and higher ICD-related concerns (ß = -0.16, p < .05) independently predicted lower perceived control. CONCLUSIONS: Interventions targeting patients' ICD concerns and psychosocial factors before, and continuing after, ICD insertion are needed to improve ICD recipients' perceived control and, in turn, their HRQOL.


Assuntos
Desfibriladores Implantáveis/psicologia , Qualidade de Vida , Adaptação Psicológica , Ansiedade/psicologia , Austrália , Estudos Transversais , Depressão/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Autorrelato , Apoio Social , Estados Unidos
13.
Patient Prefer Adherence ; 12: 1213-1224, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30034225

RESUMO

Purpose: Worldwide, stroke is a leading cause of disease burden. Many survivors have unmet needs after discharge from hospital. Electronic communication technology to support post-discharge care has not been used for patients with stroke. In this paper, we describe the development of a novel electronic messaging system designed for survivors of stroke to support their goals of recovery and secondary prevention after hospital discharge. Participants and methods: This was a formative evaluation study. The design was informed by a literature search, existing data from survivors of stroke, and behavior change theories. We established two working groups; one for developing the electronic infrastructure and the other (comprising researchers, clinical experts and consumer representatives) for establishing the patient-centered program. Following agreement on the categories for the goal-setting menu, we drafted relevant messages to support and educate patients. These messages were then independently reviewed by multiple topic experts. Concurrently, we established an online database to capture participant characteristics and then integrated this database with a purpose-built messaging system. We conducted alpha testing of the approach using the first 60 messages. Results: The initial goal-setting menu comprised 26 subcategories. Following expert review, another 8 goal subcategories were added to the secondary prevention category: managing cholesterol; smoking; physical activity; alcohol consumption; weight management; medication management; access to health professionals, and self-care. Initially, 455 health messages were created by members of working group 2. Following refinement and mapping to different goals by the project team, 980 health messages across the health goals and 69 general motivational messages were formulated. Seventeen independent reviewers assessed the messages and suggested adding 73 messages and removing 16 (2%). Overall, 1,233 messages (18 administrative, 69 general motivation and 1,146 health-related) were created. Conclusion: This novel electronic self-management support system is ready to be pilot tested in a randomized controlled trial in patients with stroke.

14.
J Adv Nurs ; 74(6): 1412-1422, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29444338

RESUMO

AIM: The aim of this study was to psychometrically evaluate the Heart Failure Screening Tool (Heart-FaST) via: (1) examination of internal construct validity; (2) testing of scale function in accordance with design; and (3) recommendation for change/s, if items are not well adjusted, to improve psychometric credential. BACKGROUND: Self-care is vital to the management of heart failure. The Heart-FaST may provide a prospective assessment of risk, regarding the likelihood that patients with heart failure will engage in self-care. DESIGN: Psychometric validation of the Heart-FaST using Rasch analysis. METHOD: The Heart-FaST was administered to 135 patients (median age = 68, IQR = 59-78 years; 105 males) enrolled in a multidisciplinary heart failure management program. The Heart-FaST is a nurse-administered tool for screening patients with HF at risk of poor self-care. A Rasch analysis of responses was conducted which tested data against Rasch model expectations, including whether items serve as unbiased, non-redundant indicators of risk and measure a single construct and that rating scales operate as intended. RESULTS: The results showed that data met Rasch model expectations after rescoring or deleting items due to poor discrimination, disordered thresholds, differential item functioning, or response dependence. There was no evidence of multidimensionality which supports the use of total scores from Heart-FaST as indicators of risk. CONCLUSION: Aggregate scores from this modified screening tool rank heart failure patients according to their "risk of poor self-care" demonstrating that the Heart-FaST items constitute a meaningful scale to identify heart failure patients at risk of poor engagement in heart failure self-care.


Assuntos
Insuficiência Cardíaca/diagnóstico , Programas de Rastreamento/métodos , Medição de Risco/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria , Reprodutibilidade dos Testes , Autocuidado , Inquéritos e Questionários
15.
Palliat Med ; 32(1): 156-163, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28678000

RESUMO

BACKGROUND: End-of-life implantable cardioverter defibrillator deactivation discussions should commence before device implantation and be ongoing, yet many implantable cardioverter defibrillators remain active in patients' last days. AIM: To examine associations among implantable cardioverter defibrillator knowledge, patient characteristics and attitudes to implantable cardioverter defibrillator deactivation. DESIGN: Cross-sectional survey using the Experiences, Attitudes and Knowledge of End-of-Life Issues in Implantable Cardioverter Defibrillator Patients Questionnaire. Participants were classified as insufficient or sufficient implantable cardioverter defibrillator knowledge and the two groups were compared. SETTING/PARTICIPANTS: Implantable cardioverter defibrillator recipients ( n = 270, mean age 61 ± 14 years; 73% male) were recruited from cardiology and implantable cardioverter defibrillator clinics attached to two tertiary hospitals in Melbourne, Australia, and two in Kentucky, the United States. RESULTS: Participants with insufficient implantable cardioverter defibrillator knowledge ( n = 77, 29%) were significantly older (mean age 66 vs 60 years, p = 0.001), less likely to be Caucasian (77% vs 87%, p = 0.047), less likely to have received implantable cardioverter defibrillator shocks (26% vs 40%, p = 0.031), and more likely to have indications of mild cognitive impairment (Montreal Cognitive Assessment score <24: 44% vs 16%, p < 0.001). Insufficient implantable cardioverter defibrillator knowledge was associated with attitudes suggesting unwillingness to discuss implantable cardioverter defibrillator deactivation, even during the last days towards end of life ( p < 0.05). CONCLUSION: Implantable cardioverter defibrillator recipients, especially those who are older or have mild cognitive impairment, often have limited knowledge about implantable cardioverter defibrillator deactivation. This study identified several potential teachable moments throughout the patients' treatment trajectory. An interdisciplinary approach is required to ensure that discussions about implantable cardioverter defibrillator deactivation issues are initiated at appropriate time points, with family members ideally also included.


Assuntos
Atitude Frente a Saúde , Desfibriladores Implantáveis/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Pacientes/psicologia , Assistência Terminal/psicologia , Suspensão de Tratamento , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
16.
J Clin Nurs ; 26(23-24): 4804-4812, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28370704

RESUMO

AIMS AND OBJECTIVES: To examine whether chronic heart failure patient-carer dyads who disagree about the division of illness management tasks (incongruent) experience poorer psychosocial health and self-care, than those who agree (congruent). BACKGROUND: Informal carers often assist patients with chronic heart failure in the complex management of their illness, but little is known about how relationship dynamics may affect psychosocial health. DESIGN: A prospective cross-sectional study was adopted with a purposeful sample of 25 chronic heart failure patient-carer dyads residing in Australia. METHODS: Data were collected via mail-out questionnaires. Dyads were classified as congruent or incongruent using the Heart Failure Care Assessment Scale. Depression, anxiety, stress and quality of life were assessed in patients and carers. Additionally, self-care and relationship quality were assessed in patients; and burden and esteem were assessed in carers. Differences in congruent and incongruent patient and carer outcomes were examined. RESULTS: Dyads were predominantly spousal and around a third demonstrated incongruence. No significant differences were found between congruent (n = 16) and incongruent (n = 9) dyads, although patients in incongruent dyads tended to have been diagnosed more recently. CONCLUSION: In chronic heart failure patient-carer dyads incongruence exists even for patients with relatively mild chronic heart failure symptoms. These findings indicate that dyadic incongruence in illness management might not affect high-functioning chronic heart failure heart failure patients or their carers. RELEVANCE TO CLINICAL PRACTICE: Given the prevalence of dyadic incongruence and the possibility of further negative outcomes with disease progression, it is important to examine factors such as length of time since diagnosis or type of carer relationship. By implementing self-care education and management strategies that focus on the dyad, rather than the individual, nurses have the potential to improve both patient and carer outcomes.


Assuntos
Cuidadores/psicologia , Gerenciamento Clínico , Insuficiência Cardíaca/psicologia , Insuficiência Cardíaca/terapia , Qualidade de Vida , Autocuidado/psicologia , Adulto , Idoso , Ansiedade/psicologia , Austrália , Doença Crônica , Estudos Transversais , Depressão/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Inquéritos e Questionários
17.
Curr Heart Fail Rep ; 14(1): 13-22, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-28243968

RESUMO

PURPOSE OF THE REVIEW: The purpose of this review was to examine the recent literature on detecting cognitive impairment in patients with heart failure (HF) and the evidence indicating any ramifications of cognitive impairment on patient engagement in HF self-care. RECENT FINDINGS: Mild cognitive impairment (MCI) is common in HF and impacts on patients' engagement in self-care, yet it is frequently not detected. The use of screening tools, even when brief, improves detection of MCI. However, the most sensitive, specific and feasible screening measure to use in practice is yet to be identified. A full neuropsychological assessment is required to determine a diagnosis of cognitive impairment and to identify the specific areas of cognitive deficit. In patients with HF, there appears to be differing clusters of cognitive deficits. Identification of these deficits may help inform the application of specific cognitive training strategies to ameliorating cognitive changes in HF patients and potentially enhance engagement in self-care. Screening for cognitive impairment is crucial in the management of HF patients to ensure that potential self-care deficits are prevented. The optimal screening tool is yet to be identified.


Assuntos
Disfunção Cognitiva/diagnóstico , Insuficiência Cardíaca/terapia , Autocuidado , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/terapia , Insuficiência Cardíaca/complicações , Humanos , Testes Neuropsicológicos
18.
Curr Heart Fail Rep ; 14(2): 71-77, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28213768

RESUMO

PURPOSE OF THE REVIEW: As described in the theory of self-care in chronic illness, there is a wide range of factors that can influence self-care behavior. The purpose of this paper is to summarize the recent heart failure literature on these related factors in order to provide an overview on which factors might be suitable to be considered to make self-care interventions more successful. RECENT FINDINGS: Recent studies in heart failure patients confirm that factors described in the theory of self-care of chronic illness are relevant for heart failure patients. Experiences and skills, motivation, habits, cultural beliefs and values, functional and cognitive abilities, confidence, and support and access to care are all important to consider when developing or improving interventions for patients with heart failure and their families. Additional personal and contextual factors that might influence self-care need to be explored and included in future studies and theory development efforts.


Assuntos
Insuficiência Cardíaca/terapia , Autocuidado/psicologia , Doença Crônica , Cultura , Família , Hábitos , Humanos , Motivação
19.
Eur J Cardiovasc Nurs ; 16(2): 157-166, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-25896588

RESUMO

BACKGROUND: Depression is common among patients with coronary heart disease (CHD) and has a major impact on their quality of life, morbidity and mortality. AIM: The aim of this study was to map the 12-month psychosocial outcomes of patients with CHD who were screened positive for depression in an acute cardiac ward. METHODS: A prospective cohort study was conducted of the psychosocial trajectory (depression, anxiety, wellbeing, social support, mental health service access) of 212 patients with CHD who were screened for depression after being admitted to acute cardiac wards of a major metropolitan hospital. Outcomes were assessed before hospital discharge and at one, three, six and 12 months post-discharge. RESULTS: Linear mixed models identified that those patients screened at 'moderate to high' risk of depression at baseline had higher levels of depression ( F(1,173)=53.93, p<0.0001) and anxiety ( F(1,180)=67.01, p<0.001), and lower levels of wellbeing ( F(1,186)=42.47, p<0.001) and social support ( F(1,177)=25.40, p<0.0001), compared to those at 'no to low' risk of depression. Levels of depression and wellbeing remained fairly constant over the 12-month trajectory. Surgical and medical treatment groups were of similar psychological composition over the 12-month period. CONCLUSIONS: These findings attest to the effectiveness and predictive validity of a simple nurse-administered screening tool designed to identify depression in hospital patients with CHD and also indicate that a screening and referral tool alone is not sufficient to achieve optimal disease management. A collaborative care model involving family members and integrated pathways to primary care is recommended.


Assuntos
Doença da Artéria Coronariana/complicações , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/etiologia , Pacientes Internados/psicologia , Pacientes Internados/estatística & dados numéricos , Atenção Primária à Saúde/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo
20.
J Adv Nurs ; 73(4): 857-870, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27779768

RESUMO

AIM: The aim of this study was to evaluate a heart failure education programme developed for patients and carers in Thailand. BACKGROUND: Heart failure is major health problem. This is the first trial of a family-based education programme for heart failure patients and carers residing in rural Thailand. DESIGN: Randomized controlled trial. METHODS: One hundred patient-carer dyads attending cardiac clinics in southern Thailand from April 2014 - March 2015 were randomized to usual care (n = 50) or a family-based education programme (n = 50) comprising face-to-face counselling, a heart failure manual and DVD and telephone support. Assessments of heart failure knowledge, health-related quality of life, self-care behaviours and perceived control were conducted at baseline, three and six months. RESULTS: Linear mixed-effects model revealed that patients and carers who received the education programme had higher knowledge scores at three and six months than those who received usual care. Among those who received the education programme, when compared with those who received usual care, patients had better self-care maintenance and confidence, and health-related quality of life scores at three and six months, and better self-care management scores at six months, whereas carers had higher perceived control scores at three months. CONCLUSION: Addressing a significant service gap in rural Thailand, this family-based heart failure programme improved patient knowledge, self-care behaviours and health-related quality of life and carer knowledge and perceived control.


Assuntos
Cuidadores/educação , Cuidadores/psicologia , Família/psicologia , Insuficiência Cardíaca/psicologia , Insuficiência Cardíaca/terapia , Educação de Pacientes como Assunto , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Tailândia
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