Illness perceptions in patients with peripheral arterial disease: A systematic review of qualitative studies

Multicomponent interventions designed to support adherence to guideline-recommended therapy in patients with peripheral artery disease: A scoping review

Adherence to guideline-recommended therapies for peripheral artery disease (PAD), including pharmacotherapy (antiplatelet, lipid-lowering, and antihypertensive agents) and lifestyle modifications (smoking cessation, diet, weight management, and physical activity) remains low. Though single-component interventions targeting smoking cessation, exercise, or medication adherence show some efficacy, comprehensive multicomponent interventions are vital for addressing the complexity of PAD management. This review systematically synthesized multicomponent interventions for patients with PAD. A systematic search was conducted in Embase, MEDLINE, Cochrane Library, APA PsycINFO, CINAHL, Web of Science Core Collection, ProQuest, and Google Scholar to identify primary research describing multicomponent interventions supporting PAD treatment adherence, published between 2007 and 2024. A narrative synthesis was reported using the Template for Intervention Description and Replication (TIDieR) checklist and the behavioral change techniques (BCT) taxonomy. Out of 15 studies (2462 patients, 60.4% men) included in this review, only two addressed all guideline-recommended treatment aspects. Key intervention components included structured exercise (12/15) and education programs (10/15). Most interventions were delivered by multidisciplinary teams in hospital settings over 3 months. Only one study employed behavioral theory in its development, and most interventions (13/15) focused on the BCT 'instructions on how to perform a behavior' rather than diverse BCTs. No interventions significantly increased adherence to all PAD therapies. Few studies measured the intervention's impact on adherence, making it difficult to determine effective intervention characteristics. Most interventions lacked behavioral science approaches and were not designed to address specific adherence determinants. Future interventions should incorporate these elements to effectively address patients' needs. Open Science Framework Registry ID: osf.io/7xqzj.

Relationship between disease perception and feelings of powerlessness in lymphoma patients: the mediating effect of social support and level of hope

Objectives

Lymphoma patients often experience significant physical and psychological stress, with feelings of powerlessness negatively impacting their health. While social support and hope are crucial for improving mood and coping with disease, their mechanisms in relation to disease perception and powerlessness remain unclear. This study aimed to examine the relationship between disease perception and feelings of powerlessness in lymphoma patients, focusing on the mediating roles of social support and hope.

Methods

For a cross-sectional design, 311 lymphoma patients were surveyed using the Brief illness perception questionnaire, Powerlessness assessment tool, Social Support Rating Scale, and Herth's Hope Scale, and were statistically analyzed using the software SPSS 27.0 and PROCESS version 4.1.

Results

A correlation was found between the disease perception, social support, hope level, and feeling of powerlessness of lymphoma patients (P < 0.01). There was a positive correlation between perceptions of illness and powerlessness (β= 0.291, P<0.001), and disease perception could influence powerlessness through three indirect pathways: the separate mediating effect of social support [β= 0.057, 95%CI (0.029~0.091)], the separate mediating effect of level of hope [β= 0.07, 95%CI (0.034~ 0.107)], and the chain mediating effect of social support and hope level [β= 0.019, 95%CI (0.008~0.033)]. Social support and level of hope played a partial medium mediating effect in the effect of perceived disease on feelings of powerlessness, accounting for 13.04% and 16.02% of the total effect, respectively, and the chained mediating effect of both accounted for 4.35% of the total effect.

Conclusions

Disease perception and powerlessness were positively correlated in lymphoma patients, and in addition, social support and level of hope mediated the relationship. This conclusion provides a theoretical basis and guidance for nursing interventions to reduce powerlessness in lymphoma patients.

Analysis of the characteristics and illness comprehension bias among Chinese patients with psycho-cardiovascular disease: a multi-centre cross-sectional survey

Background

Psychological distress, such as depression and anxiety, impacts cardiovascular disease (CVD) prognosis and management. Illness comprehension is essential for effective treatment, but biases can lead to suboptimal outcomes. We explored psycho-cardiovascular disease (PCD) patient characteristics, with a specific focus on comprehension biases and treatment choices from patients' perspectives in China, to improve management strategies.

Methods

We enrolled 864 PCD patients in Chinese hospitals across 11 provinces. Tools included the seven-item General Anxiety Disorder scale, the nine-item Patient Health Questionnaire, and a self-designed PCD illness comprehensibility survey. We used χ2 test, univariate, and multivariate logistic regression to examine patient characteristics.

Results

Of 834 enrolled PCD patients, over 90% experienced mild to moderate anxiety and depression, yet less than 10% received treatment. 52.90% of patients had high illness comprehension. Among the high comprehension group, there were fewer labourers (19.30% vs. 26.40%; P < 0.05), fewer older individuals (39.20% vs. 46.90%; P < 0.05), and those with lower household income (15.60% vs. 30.50%; P < 0.05). A greater proportion of those in the high comprehension group lacked insurance (17.50% vs. 10.00%; P < 0.05), and they were more highly educated (42.90% vs. 32.10% with a college education). Additionally, more patients in the high comprehension group frequently received psychological consultation (24.00% vs. 5.10%; P < 0.05) and therapy (7.70% vs. 2.30%; P < 0.05). These patient groups preferred tertiary hospitals (71.66% vs. 63.33%; P < 0.05) and psycho-cardiovascular clinics (40.14% vs. 25.90%; P < 0.05). In comparison, low comprehension patients prioritised cost (32.65% vs. 46.41%; P < 0.05) and favoured a transition to community hospitals (16.55% vs. 25.38%; P < 0.05).

Conclusions

More than 90% of PCD patients in Chinese CVD departments experience mild to moderate anxiety and depression with low treatment rates. Different illness comprehension levels are associated with variations in treatment willingness, considerations, health care preferences, medication choices, and illness knowledge acquisition methods.

Lived experiences and illness perceptions of older adults with age-related hearing loss before the use of hearing aids: An interpretative phenomenological study

Age-related hearing loss is a chronic health condition. This qualitative study applied the Common-Sense Model of Self-Regulation to explore the lived experiences and illness perceptions of older adults with age-related hearing loss. Twenty older adults ≥ 65 years of age with hearing loss were recruited by purposive sampling. Data were collected with face-to-face semi-structured interviews. Interpretive phenomenological analysis analyzed the interview data. Four overarching themes described the experience of hearing loss: 1) awareness, 2) impacts, 3) coping, and 4) appraisal. These highlight of how participants perceived and reacted to progressive hearing loss before adopting hearing aids. The impact of hearing loss was diverse and complex and included fatigue, stress, and interpersonal conflicts. Participants responded with changes in behaviors that were proactive or avoidant. Our findings may help clinicians understand how older adults perceive and manage age-related hearing loss, which could guide the development of effective individual and family-focused interventions.

Orem's Self-Care Deficit Nursing Theory with Persons with Peripheral Artery Disease: A Mixed Method Study

This study was conducted to determine the effects of an algorithm training booklet, which was based on Orem's self-care deficit nursing theory, specific to lower extremity peripheral artery disease, on pain, activities of daily living, self-care agency, walking distance, quality of life, and other symptoms. This mixed-method study included a qualitative stage using face-to-face in-depth individual interviews and a pretest-posttest semiexperimental design quantitative stage. In-depth interviews were conducted to highlight self-care needs and symptoms and to create the booklet. The booklet's content was prepared in line with concepts of Orem's theory. The patients were educated with the direction of the booklet and evaluated on outcomes. The data were evaluated using percentage distribution, means, Mann-Whitney U test, and Friedman test. Three categories were identified through the thematic analysis. It was determined that patients had lower pain score and higher activities of daily living, self-care, walking distance, and quality of life scores after the training.

Patients with chronic limb-threatening ischemia: Experiences of their disease, treatment, and care in a cross-sectoral setting. A scoping review

INTRODUCTION

Patients facing chronic limb-threatening ischemia (CLTI) experience significant burdens, impacting their physical, emotional, and social well-being. They require extensive care from multidisciplinary healthcare professionals across primary and secondary settings. Managing CLTI necessitates strict patient adherence to treatment protocols to prevent severe complications. Surprisingly, previous studies have overlooked these patients' unique perspectives, highlighting the need to explore their experiences and challenges.

OBJECTIVE

The objective of this review was to systematically identify, examine, and conceptually map extant literature on patients with CLTI in the context of living with the condition, and explore their experiences of receiving treatment and care within a cross-sectoral setting.

METHODS

A systematic search was completed on 18 September 2023 with no methodological or format restrictions. We identified the population, concept, and context to pinpoint the delineate the focus of this review process. The JBI methodology for scoping reviews and the PRISMA-ScR checklist were followed.

RESULTS

Based on our search, we found ten relevant scientific qualitative and/or quantitative sources and one non-scientific source. We identified four main maps: 1) Dependency on others is my new life condition, 2) I'm more than the sum of my conditions, 3) I'm lost in chaos, be alert to all of me, and 4) Give me more time, my body and mind are under attack.

CONCLUSION

This scoping review describes how patients' lives are affected by CLTI and provides insights into their perception of shared decision-making, treatment, and care. The review reveals the need for a more person-centered approach to care. To nuance person-centred care further, it is necessary to consider the impact of patients' cultural values and preferences. However, this area is marked by a notable research gap.

Illness beliefs relation to physical activity and quality of life in patients with peripheral arterial disease

Intermittent claudication is the most common symptom of Peripheral Arterial Disease (PAD) and is associated with decreased quality of life (QoL) due to walking impairment. The level of threat attributed to the disease affects QoL and physical activity. This study explores beliefs and illness drawings, and their relationship with quality of life and physical activity in patients undergoing conservative treatment for PAD. A cross-sectional study was carried out including 119 patients with PAD and Intermittent Claudication, in which patients were asked to freely draw their disease and 33 agreed to participate. The profile of beliefs about PAD is characterized by a low level of threat. Belief in the emotional impact of the disease, representations about the consequences and concern about the disease were associated with worse quality of life; the belief of having a high personal control over the disease was associated with more physical activity. The analysis of the disease drawings revealed three categories: extension of the disease (category 1), location and representations of the disease (category 2), and level of detail and complexity of the drawings (category 3). Greater disease extent was associated with more disease symptoms (IPQ 6) (rs = 0.399, p = .021). It is necessary to address beliefs and representations about the disease in consultations with patients with PAD. Patient drawings are a useful, practical, and free tool that does not require a lot of time and can facilitate the approach of health professionals to patient training and education.

Parents' illness representations of their child with anorexia nervosa: A systematic review of qualitative studies using the common-sense model

OBJECTIVE

Research indicates that parents experience distress while caring for a child with anorexia nervosa. Applying the Common Sense Model of Self-Regulation (CSM), a framework to describe responses to illness may help to understand the antecedents of parental distress, which could inform how to support parents in treatment. The aim of this systematic review was to synthesize outcomes from qualitative research in relation to parents' experiences of caring for a child with anorexia nervosa using the CSM.

METHOD

Systematic search of four electronic databases (psychINFO, MEDLINE, EMBASE, ProQuest Dissertation, and Theses Database) alongside a two-way screening process was used to identify eligible studies. Qualitative themes were synthesized using a "best fit" framework analysis and reported according to CSM dimensions of cognitive and emotional illness representations.

RESULTS

A total of 32 studies published between 1970 and 2023 were eligible for inclusion for review. Parents perceived their child's anorexia nervosa as a major health threat observable by illness representations that anorexia nervosa was uncontrollable, incomprehensible, chronic, and associated with negative consequences. The themes also suggested parents take responsibility for causing anorexia nervosa. These illness representations were linked with emotional representations of fear, anxiety, shame, guilt, loneliness, and depression.

CONCLUSIONS

The findings provide evidence of the utility of using the CSM to understand the antecedents of parents' distress and negative impacts of caring for a child with anorexia nervosa. Recommendations for future research and clinical practice are discussed emphasizing the need to understand parents' perceptions of their child's illness to putatively maximize treatment benefits for families.

PUBLIC SIGNIFICANCE

This review emphasizes the salience of understanding parents distress while caring for a child with anorexia nervosa. The findings present opportunities to best support parents in treatment, with a focus on addressing their cognitive and emotional representations of their child's illness. A multicomponent treatment regimen may be required to support parents if they present with illness representations that negatively affect their well-being and ability to cope with distress.

Inconsistent Benefits From Mobile Information Communication Technology in Adults With Peripheral Arterial Disease

INTRODUCTION

Quality of evidence regarding telemedicine in adults with peripheral arterial disease has not been systematically appraised.

OBJECTIVES

To explore benefits and harms from mobile information communication technology devices and applications in peripheral arterial disease.

METHODS

Systematic rapid evidence review and appraisal with the grading of recommendations assessment, development, and evaluation working group approach.

RESULTS

Sixteen randomized controlled clinical trials (RCT) examined various self-monitoring devices, telemedicine platforms, and individualized telephone counseling. Low-quality evidence suggested that the odds of treatment failure (pooled Peto odds ratio 0.8; 95% CI, 0.4-1.7; 5 RCTs), adverse effects (pooled Peto odds ratio 0.9; 95% CI, 0.5-1.5; 2 RCTs), and physical performance (standardized mean difference in 6-minute walking test 0.2; 95% CI, -0.3-0.7; 4 RCTs) did not differ between mobile interventions and usual care. Single RCTs suggested large but inconsistent improvement in the quality of life: EuroQol5D standardized mean difference = 5.0 (95% CI, 4.4-5.7; 1 RCT) after telehealth program for promoting patient self-management and standardized mean difference = 1.4 (95% CI, 0.4-2.3; 1 RCT) after structured rehabilitation with mobile self-monitoring. Inconsistent reporting of patient-centered outcomes and small sample sizes hampered the quality of evidence.

CONCLUSIONS

Improved quality of life after specific mobile applications should be confirmed in powered RCTs and large postmarketing studies.

A Scoping Review of Measurement Tools Evaluating Awareness and Disease-Related Knowledge in Peripheral Arterial Disease Patients

BACKGROUND

Peripheral arterial disease (PAD) is the third leading cause of atherosclerotic cardiovascular morbidity worldwide, with high prevalence and associated complications, and is often overlooked and undertreated. Research has shown that there is a profound lack of PAD-related knowledge and awareness; additionally, information sources are not often reliable and accessible. The objective of this scoping review was: (1) to identify and critically appraise instruments that measure patients' disease-related knowledge/awareness about PAD, and (2) to characterize the current state of knowledge/awareness levels among these patients.

METHODS

This systematic review was conducted and reported in accordance with the PRISMA statement. Six databases (APA PsycInfo, CINAHL Ultimate, Embase, Emcare Nursing, Medline ALL and Web of Science Core Collection) were searched, and search strategies were developed utilizing the PICO framework. Potential studies of any methodological design were considered for inclusion through a snowball hand search. Data from the included articles were extracted by a reviewer, and the extraction accuracy was independently cross-checked by another author.

RESULTS

The initial database search yielded 9832 records, of which sixteen studies (thirteen quantitative and three qualitative) were included. Only three questionnaires had their psychometric properties assessed. Questionnaire items focused on the following topics: definition/characteristics, risk factors/causes, treatment, complications, and personal issues regarding the perception/management of the disease. Overall, knowledge/awareness about PAD was low among patients.

CONCLUSIONS

This study identified major gaps in PAD education, including the lack of availability of a validated measurement tool addressing all educational topics relevant to care and low knowledge/awareness of patients about their condition.

Illness perception, health literacy, self-efficacy, adherence and quality of life in patients with intermittent claudication - a longitudinal cohort study

BACKGROUND

Patients with intermittent claudication need lifelong treatment with secondary prevention to prevent cardiovascular events and progression of atherosclerotic disease. Illness perception, health literacy, self-efficacy, adherence to medication treatment, and quality of life are factors influencing patients' self-management. Knowledge of these factors could be important when planning for secondary prevention in patients with intermittent claudication.

AIM

to compare illness perception, health literacy, self-efficacy, adherence to treatment, and quality of life in in patients with intermittent claudication.

METHODS

A longitudinal cohort study was conducted with 128 participants recruited from vascular units in southern Sweden. Data were collected through medical records and questionnaires regarding illness perception, health literacy, self-efficacy, adherence to treatment, and quality of life.

RESULTS

In the subscales in illness perception, patients with sufficient health literacy reported less consequences and lower emotional representations of the intermittent claudication. They also reported higher self-efficacy and higher quality of life than patients with insufficient health literacy. In comparison between men and women in illness perception, women reported higher illness coherence and emotional representations associated with intermittent claudication compared to men. A multiple regression showed that both consequences and adherence were negative predictors of quality of life. When examining changes over time, a significant increase in quality of life was seen between baseline and 12 months, but there were no significant differences in self-efficacy..

CONCLUSION

Illness perception differs in relation to level of health literacy and between men and women. Further, the level of health literacy seems to be of importance for patients' self-efficacy and quality of life. This illuminates the need for new strategies for improving health literacy, illness perception, and self-efficacy over time. For example, more tailored information regarding secondary prevention could be provided to strengthen self-management to further improve quality of life in patients with intermittent claudication.

Role of the advanced nurse practitioner within the vascular team: A qualitative study of vascular physicians and nurses

Objective

To assess the perception of Advanced Nurse Practitioners (ANP) by physicians and nurses in vascular medicine. As the status of ANP in France was recently enacted by law in 2018, we aimed to investigate physicians and nurses working with patients suffering from Peripheral Artery Disease (PAD) to gather their opinions and draw the cooperation outlines these practitioners could have with an ANP.

Methods

A qualitative study based on in-depth interviews was conducted among healthcare practitioners taking care of patients with PAD: 10 physicians working either in a private practice settings or hospital settings or both, and eight nurses working within a hospital inpatients vascular unit. Verbatim responses were extracted and coded according to a continuous thematization method.

Results

Three main features emerged from participants' responses. Vascular medicine has a specific organization with a significant lack of time and staff to fulfill the mission regarding patients' severity of illness. Second, the ANP is wanted to fill part of this gap. The expected benefits include a smoother care pathway and increased capacity for cardiovascular education and prevention, especially during consultations. Lastly, some clarification is required to integrate such new practitioners within vascular teams already in place.

Conclusion

Advanced nurse practitioners could be the missing link in a "Vascular team" by creating a continuum in the care of patients with PAD, ensuring clinical assessment, nursing supervision, adverse event screening, and renewing drug prescriptions with the required adaptations while ensuring essential part of therapeutic education adapted to each patient.

Factors associated with self-management after hybrid revascularization in patients with peripheral artery disease: A structural equations model

AIM

To investigate the factors associated with self-management after hybrid revascularization in patients with lower extremity peripheral artery disease using a structural equation modelling approach.

DESIGN

A cross-sectional study was adopted.

METHODS

A total of 221 patients who underwent hybrid revascularization for peripheral artery disease of the lower limbs were included from outpatient clinics at a 1200-bed tertiary care hospital in Korea. Data were collected using a self-reported questionnaire between December 1, 2019, and August 31, 2020. Structural equation modelling was applied to test the hypothetical model.

RESULTS

The item mean score of participants' self-management was 6.28 (standard deviation, 0.83) out of 8. The structural equation modelling had a good fit index. Autonomy support from healthcare providers was directly associated with self-management (β = 0.20, p = 0.041). Illness perception directly (β = -0.33, p = 0.031) and indirectly (β = -0.19, p = 0.032) influenced self-management through competence and relatedness in patients with peripheral artery disease. The construct of autonomy support from healthcare providers, illness perception, competence and relatedness accounted for 49% of the variance in self-management. The Sobel test confirmed the statistically significant mediating effects of competence (z = -4.52, p < 0.001) and relatedness (z = -2.12, p < 0.001) on the relationship between illness perception and self-management.

CONCLUSION

Our findings revealed that autonomy support from healthcare providers and patients' illness perception directly influenced patients' self-management. Additionally, patients' illness perception can indirectly influence self-management through their perceived competence and relatedness.

IMPACT

Healthcare providers' autonomy support to patients may promote self-care behaviours, leading to greater autonomous motivation. Assessment of patients' illness perception before patient education is vital to designing effective self-management strategies which can improve patients' perceived competency and meaningful relatedness with healthcare providers.

A Review of Illness Perceptions in Chronic Limb-Threatening Ischemia: Current Knowledge Gaps and a Framework for Future Studies

OBJECTIVES

To review illness perceptions (IP) in chronic limb-threatening ischemia (CLTI) patients undergoing revascularisation (open surgical or endovascular), major lower extremity amputation, or conservative management.

METHODS

MEDLINE, EMBASE, PsycINFO, CINAHL, WOS, and Scopus databases were searched from inception to August 20^th, 2021 for studies evaluating IP in CLTI according to Leventhal's Common-Sense Model (CSM). Since only one study was identified, a post-hoc secondary literature search of MEDLINE was performed for reviews of IP in cardiovascular disease and diabetes to identify potential learning points for future research. All studies underwent narrative synthesis guided by tabulated data.

RESULTS

One study and seven reviews were included from the primary and secondary literature searches, respectively. Timeline and controllability were the main aspects of IP that predict prosthetic use in CLTI patients, more so at six months than one month. Other reviews in cardiovascular disease and diabetes identified important targets for future research: (i) factors that affect IP and whether IP can be used as an outcome measure, (ii) relationship between IP and clinician-reported and patient-reported outcomes, and (iii) methods to educate and change maladaptive IP. The importance of using valid and reliable measures of IP that encompass all components of Leventhal's' CSM was stressed.

CONCLUSIONS

Knowledge of IP in CLTI patients is severely limited in contrast to other fields in cardiovascular disease and diabetes. This review helps to close this gap by raising awareness of IP and its importance within the vascular surgical community, and by providing a framework for future studies.

Relationship between illness perception, fear of progression and quality of life in interstitial lung disease patients: A cross-sectional study

AIMS AND OBJECTIVES

This study aimed to investigate whether fear of progression mediates the association between illness perception and quality of life among interstitial lung disease patients.

BACKGROUND

So far, the physiological treatment of interstitial lung disease is limited. In addition to immunosuppressants such as glucocorticoids, two anti-fibrosis drugs (pirfenidone and nintedanib) have shown moderately beneficial effects on slowing the progression of interstitial lung disease fibrosis. However, none of these drugs has shown reliable or strong beneficial effects on improving quality of life. Psychological care and mental health support strategies focusing on improving patients' quality of life are particularly important.

DESIGN

A cross-sectional study.

METHODS

A convenience sample of patients suffering from interstitial lung disease were enrolled from August to December 2019. Data including sociodemographic and clinical characteristics, illness perception, fear of progression and quality of life were collected. The descriptive analysis and Pearson correlations were analysed by SPSS 26.0 (IBM Corp.). PROCESS v3.4 (by Andrew F. Hayes) macro was applied to analyse the mediating effects. We used the STROBE checklist to report the results.

RESULTS

Both illness perception and fear of progression were correlated with quality of life. Fear of progression mediated the association between illness perception and quality of life. The indirect effect was 0.121, and the proportion of intermediary effect in the main effect was 26.36%.

CONCLUSION

Interstitial lung disease patients experience relatively poor quality of life and fear of progression exerts a mediating role between illness perception and quality of life.

RELEVANCE TO CLINICAL PRACTICE

This study alerts medical staff to pay attention to negative illness perception and excessive fear, which is helpful to formulate effective interventions to manage interstitial lung disease patients' quality of life.