Life course of people with coronary artery disease

Patients expectations and fulfilment of expectations before and after treatment for suspected coronary artery disease assessed with a newly developed questionnaire in combination with established health-related quality of life questionnaires

Background

Clinical decision-making is often based on evidence of outcome after a specific treatment. Healthcare providers and patients may, however, have different perceptions and expectations of what to achieve from a certain healthcare measure.

Aims

To evaluate patients’ expectations, perceptions and health related quality of life (HRQoL) before a care process including coronary angiography for suspected coronary artery disease and to evaluate the fulfilment of these expectations in relation to established patient reported outcome measures (PROMs) 6 months later. Furthermore, an aim was to try to define meaningful patient reported experience measures (PREMs) in this population.

Methods

544 patients planned for coronary angiography completed a newly developed questionnaire to assess expectations and perceptions of treatment, the expectation questionnaire (ExpQ) and two established HRQoL questionnaires together with the established generic Short-Form 36 (SF36) and the disease specific Seattle Angina Questionnaire (SAQ).

Results

Patients had before the intervention, in general, high expectations of improvement after investigation and treatment and there was a positive attitude towards life style changes, medication and participation in decision-making regarding their own treatment. Only, 56.4% of the patients, however, reported fulfilment of treatment expectations. Fulfilment of treatment expectations correlated strongly with improvement in HRQoL after the care process.

Conclusions

To measure patients ´ expectations and fulfilments of these may offer simple and meaningful outcomes to evaluate a healthcare process from a patient ´s perspective. To approach patients’ expectations may also strengthen patient involvement in the care process with the possibilities of both higher patient satisfaction and medical results of the treatment.

Fragility—The Price of Renewed Life. Patients Experiences of Open Heart Surgery

Background: Open heart surgery often implies a threat to life and is associated with fear and anxiety. It is also a strong encroachment on body and integrity and adjusting life afterwards could be difficult. Despite improvements in treatment the patients' reactions appear to be unchanged. Introducing a lifeworld perspective would supply a different kind of knowledge based upon the patients' own experiences coloured by their linguistic usage and bodily expressions.

Aim: The aim of this study was to describe patients' experiences of open heart surgery in a lifeworld perspective.

Method: Fourteen patients treated with coronary artery bypass surgery and/or heart valve operation were in-depth interviewed in 2003. The phenomenological method was used for the interviews as well as for the analysis. The informants reflected on their experiences of the illness, meetings with health care, family relations and wishes for the future.

Findings: The essence of the phenomenon was fragility. Fragility was understood through the following categories: distance, uncertainty, vulnerability, reliance and gratitude.

Conclusions: Patients want to be treated as unique individuals. They ask for more dialogues with the staff. Awareness of their supposed lifelong fragility implies that health care staff acquires an open and holistic approach.

Restenosis after Percutaneous Coronary Intervention (PCI): Experiences from the Patients' Perspective

BACKGROUND

PCI has been established as an effective treatment for coronary artery disease. Restenosis is a recurrence of a significant narrowing in the treated vessel. Although a part of the investigative and research funding is invested in the prevention and resolving the restenosis problem, little is known about its clinical significance apart from further revascularisation.

AIM

The intention of this study was to clarify the patients perspective of what it means to suffer from documented restenosis after PCI.

METHOD

Patients interviewed had undergone PCI. Data collection and analysis was done simultaneously according to Grounded Theory methodology and continued until new interviews provided no additional information.

RESULTS

"Living with uncertainty" was identified as the core category, and the central focus in the data explains what it means to patients' to suffer from restenosis. The core category was further illuminated in four additional categories labelled "fighting for access to care", "moderating health threats", "trying to understand" and "controlling relatives anxiety".

CONCLUSION

Patients' perceptions of illness and illness-related events, such as symptoms, diagnosis, treatment and prognosis, are considerably affected by uncertainty. This infiltrates their struggle to acquire the care needed, their endeavour to comprehend and moderate health threats, and caring for their family.

Women and cardiac rehabilitation: A review of the literature

There is a wide variety of literature available about coronary heart disease (CHD). However much of the research related to CHD has been performed using either exclusively male populations or such small numbers of women that the results from the women studied were unable to be analysed independently. It is apparent that more researchers are focusing on research that examines women's responses to CHD and the care and treatment they receive. The following literature review explores some of the issues related to women's experience of cardiac rehabilitation and demonstrates that women's experience of cardiac rehabilitation may be different to that of men. There is a need for nurses working within this area of practice to have an understanding of women's experience of recovery from a heart attack in order to better meet their needs.

Patients' experiences from symptom onset to initial treatment for atrial fibrillation

AIMS AND OBJECTIVES

To describe patients' experiences from symptom onset to initial treatment for atrial fibrillation.

BACKGROUND

The estimated number of individuals with atrial fibrillation globally in 2010 was 33·5 million. World-wide, each year, new cases of atrial fibrillation approach 5 million, and prevalence will increase 2·5-fold by 2050. As a result, clinicians worldwide will treat a growing number of patients with atrial fibrillation. Early intervention to promote atrial fibrillation self-management is critical to reduce associated complications of stroke and heart failure. Greater understanding of patients' experiences from symptom onset to initial treatment for atrial fibrillation is needed to guide development of interventions to promote early effective self-management.

DESIGN

A descriptive qualitative design was used.

METHODS

Twenty females and 21 males at an academic medical centre were interviewed using open-ended questions to explore their experiences from symptom onset to initial treatment for atrial fibrillation. Data were analysed using qualitative content analysis.

RESULTS

Participants' mean age was 64·3 (SD = 10·1) years. Four themes were identified: (1) misinterpreting symptoms; (2) discovering the meaning of atrial fibrillation; (3) facing fears, uncertainty, and moving to acceptance; and (4) receiving validation and reassurance. Participants lacked knowledge of atrial fibrillation and took cues from providers' responses to appraise symptoms and diagnosis. Fear and uncertainty were reduced when providers initiated prompt treatment and took time to explain atrial fibrillation. Patients appreciated receiving clear information about atrial fibrillation, were engaged in learning, and motivated to participate in their care.

CONCLUSIONS

Providers played a critical role in helping patients to develop an accurate understanding of atrial fibrillation, to cope with the new diagnosis, and motivated them to engage in effective self-management.

RELEVANCE TO CLINICAL PRACTICE

Insight into participant experiences from symptom onset to initial treatment for atrial fibrillation may inform development of interventions to promote effective atrial fibrillation self-management.

Role of psychosocial care on ICU trauma

CONTEXT

Patients treated in intensive care units (ICU) though receive the best medical attention are found to suffer from trauma typically attributed to the ICU environment. Biopsychosocial approach in ICUs is found to minimize ICU trauma.

AIMS

This study investigates the role of psychosocial care on patients in ICU after coronary artery bypass graft (CABG).

SETTINGS AND DESIGN

The study included 250 post-operative CABG patients from five corporate hospitals. The combination of between subject and correlation design was used.

MATERIALS AND METHODS

The ICU psychosocial care scale (ICUPCS) and ICU trauma scale (ICUTS) were used to measure the psychosocial care and trauma.

STATISTICAL ANALYSIS

ANOVA and simple and multiple regression were applied.

RESULTS

Hospitals significantly differed in psychosocial care provided in ICUs. Higher the psychosocial care in ICU, lower was the ICU trauma experienced and vice versa. Psychosocial care was a significant major predictor of ICU trauma.

CONCLUSIONS

The study suggests emphasis on psychosocial aspects in ICU care for optimizing prognosis.

Critical review of factors predicting health-related quality of life in newly diagnosed coronary artery disease patients

BACKGROUND

Newly diagnosed coronary heart disease patients can experience significant negative changes in their health-related quality of life (HRQoL). No existing literature review was found related to factors predicting HRQoL in newly diagnosed coronary heart disease patients.

PURPOSE

The aim of this study was to identify factors predicting HRQoL in newly diagnosed coronary heart disease patients.

REVIEW METHODS

We searched studies published between 1997 and 2009 with combinations of key words including factors, predictor, health-related quality of life, quality of life, first diagnosed coronary heart disease patients, and coronary heart disease patients. Data sources were ProQuest, ScienceDirect, CINAHL, PsychINFO, PubMed, and Scopus. Seventeen studies were identified that primarily examined HRQoL from 6 weeks to 12 months after diagnosis.

CONCLUSIONS

Factors predicting HRQoL in newly diagnosed coronary heart disease patients can be divided into 3 groups: sociodemographic, clinical, and psychosocial. Characteristics in each category most strongly predictive of HRQoL in newly diagnosed coronary heart disease patients were: Sociodemographic positive predictors were baseline HRQoL, education level, and marital status; sociodemographic negative predictors included number of cardiovascular risks and female gender. Age was an inverse predictor. Clinical negative predictors included angina, physical functioning, and fatigue. Psychosocial positive predictors included social support and a sense of coherence, whereas depression, anxiety and depression, overall psychosocial characteristics or mood disturbance, anxiety, and hostility were negative predictors.

CLINICAL IMPLICATIONS

This review identifies predictors of HRQoL and shows the importance of assessing factors that predict HRQoL at baseline and throughout the trajectory of this chronic illness because the concept of HRQoL changes over time but the predictors remain constant.

Patients' narrative accounts of open-heart surgery and recovery: authorial voice of technology

In this narrative inquiry, we examined patients' experiential accounts of technology in open-heart surgery and recovery. A convenience sample of sixteen individuals was recruited from a preoperative clinic at a regional centre for cardiac services in Canada. Each participated in two interviews following transfer from cardiovascular intensive care and 4-6 weeks post discharge from the hospital. Participants also documented their experiences in journals during the first 3-4 weeks following discharge. The focal point of the study's theoretical foundations was narrative emplotment, which directs attention to the active processes of plot construction and shaping forces of stories. In our narrative analysis, we used narrative mapping to document the temporal flow of events. We found that technology acted as the authorial voice, or controlling influence, over how participants' narratives were shaped and unfolded. Key were the ways in which technology as the authorial voice was linked with participants becoming background characters and surrendering agency. Problematic and important to health care professionals is ensuring that authorial voice shifts back to patients so that they become active in shaping their own course of recovery. This study underscores the benefits of using literary techniques such as narrative analysis in health science research. Examining the narrative structures and forces that shape patients' stories sheds light on how health care professionals and their technologically-driven practices of care strongly affect the stories' content and how they unfold. By focusing on how stories unfolded, we revealed ways in which cardiac surgery practices and patients' course of recovery could be enhanced.

The use of the life course paradigm and life course charts to explore referral for family history of breast cancer

BACKGROUND

Life course research methodologies are used extensively in historical and social science research. In 1998 the life course paradigm was introduced to provide a way of tracing the interplay of person and setting. The method has had a very limited use in nursing research, but in this study it was utilized as a way of capturing dynamic change by placing the individual within a context of four domains; location in time and place, linked lives, human agency and timing of lives.

OBJECTIVE

To describe the paradigm, review its use in healthcare research and provide a specific example of its use in healthcare.

DESIGN

This paper discusses a novel method of creating life course charts for a qualitative study exploring the differing experiences of women referred from primary care to specialist services due to a family history of breast cancer.

SETTING

A nurse-led breast cancer family history clinic in the UK.

PARTICIPANTS

Twenty-two women.

METHODS

Life charts were used in conjunction with a grounded theory approach to analyse data collected from semi-structured interviews.

FINDINGS

Twenty-two life charts were created and the ability to layer the charts of multiple women to visualise similarities and differences aided the analysis. The life charts were a useful tool in the development of theoretical understandings and the psychosocial process of realisation of risk emerged as central to the initiation of referral. This was often apparent when approaching the age of an affected relative (anticipated onset) or when current circumstances emulate past experience (generational transference).

CONCLUSIONS

This approach to charting complex psychological, social and contextual factors throughout the life course was methodologically beneficial and could have a wider utility in nursing and healthcare research. As a research tool it enhanced a holistic approach to patient care issues and was helpful as an aid to understanding health behaviours linked to familial risk.

Patient feelings during the preoperative period for cardiac surgery

This qualitative study aimed to identify the feelings patients presented when confronted with the news about the need to undergo cardiac surgery and, later, during the preoperative period. Twenty male patients were interviewed. The case study methodology was adopted and the analysis process resulted in two theme categories: Feelings of apprehension (fear, worry, anxiety, suspicion and jittery) and Positive and hopeful feelings. We observed that, although both categories were present at the two moments, over time, during the preoperative period, the need for surgical intervention was accepted better and the Feelings of apprehension started to be mentioned less, while the Positive and hopeful feelings were most frequently mentioned by the patients.

Women, men and coronary heart disease: a review of the qualitative literature

AIM

This paper presents a review of the qualitative literature which examines the experiences of patients with coronary heart disease. The paper also assesses whether the experiences of both female and male patients are reflected in the literature and summarizes key themes.

BACKGROUND

Understanding patients' experiences of their illness is important for coronary heart disease prevention and education. Qualitative methods are particularly suited to eliciting patients' detailed understandings and perceptions of illness. As much previous research has been 'gender neutral', this review pays particular attention to gender.

METHODS

Published papers from 60 qualitative studies were identified for the review through searches in MEDLINE, EMBASE, CINAHL, PREMEDLINE, PsychINFO, Social Sciences Citation Index and Web of Science using keywords related to coronary heart disease.

FINDINGS

Early qualitative studies of patients with coronary heart disease were conducted almost exclusively with men, and tended to generalize from 'male' experience to 'human' experience. By the late 1990s this pattern had changed, with the majority of studies including women and many being conducted with solely female samples. However, many studies that include both male and female coronary heart disease patients still do not have a specific gender focus. Key themes in the literature include interpreting symptoms and seeking help, belief about coronary 'candidates' and relationships with health professionals. The influence of social roles is important: many female patients have difficulties reconciling family responsibilities and medical advice, while male patients worry about being absent from work.

CONCLUSIONS

There is a need for studies that compare the experiences of men and women. There is also an urgent need for work that takes masculinity and gender roles into account when exploring the experiences of men with coronary heart disease.

Exploring gender and socioeconomic differences in treatment of coronary heart disease

BACKGROUND

Earlier studies on gender and socioeconomic differences in the treatment of coronary heart disease have focused mainly on structural features of the health-care system on the one hand and on coronary patients' psychosocial characteristics on the other. The aim of this exploratory qualitative study was to trace key points in the pathways of treatment where patients' experience varies and which can contribute to gender and socioeconomic differences in treatment.

METHODS

The data consist of 30 interviews among persons diagnosed with or suspected to have coronary heart disease in the Health 2000, a representative cross-sectional interview and health examination survey. Purposive sampling was used to ensure variation in gender, socioeconomic status and disease severity. The data were analysed using qualitative content analysis.

RESULTS

Gender and socioeconomic differences were found in two key points in the pathways of treatment: doctor-patient interaction and the organization of primary care. The three features commonly distinguished in doctor-patient interaction, i.e. treatment decision-making, information exchange and interpersonal relationship, were all found to be relevant. A second key point was organization of primary care in terms of both access to examinations and care, and continuity of care.

CONCLUSIONS

These results should sensitize us to gender and socioeconomic differences in coronary patients' problems in access to and continuity of care, as well as to potential problem areas in doctor-patient interaction.

The illness experiences of patients after a first time myocardial infarction

The purpose of this study was to investigate illness experiences of patients after a first myocardial infarction (MI), focusing on life situation and the recovery process over time. Thirty patients were interviewed within the first 3 days of hospitalisation, and again 17 weeks after discharge. The interviews were tape-recorded verbatim and the transcriptions were analysed and categorised using qualitative content analysis. The main category was Uncertainty of the life situation that was combined with and articulated the superior theme in both interviews. Analyses revealed uncertainty focused on problems related to: treatment-seeking behaviour; existential threat; preventing another coronary and need for knowledge and support, which the patients considered important for their case and future life. The findings are fundamental for the health care when education and counselling are planned and challenge health care personnel to listen to MI-patients' own experiences.

Fear and anxiety in patients at different time-points in the coronary artery bypass process

The purpose of this study was to examine fear and anxiety of coronary artery bypass patients at different time-points in the coronary artery bypass process and changes between different time-points. Patients (n = 171) from one university hospital completed questionnaires while awaiting surgery at home, in hospital the evening before surgery and 3 months later. The Bypass Grafting Fear scale was developed to measure fear. Anxiety was measured using state-trait-anxiety inventory and HAD. The highest levels of fear and anxiety were measured in the waiting period to coronary artery bypass grafting (CABG). Compared with the waiting period, fear and anxiety levels dropped in hospital and 3 months later. Female gender was related to change in fear and HAD anxiety. Marital status and vocational education were related to changes in STATE-A. Age under 55 years was related to higher TRAIT-A especially in the recovery period. These findings warrant concern for fear and anxiety in patients awaiting CABG, especially women and patients who do not have partner relationship.

Weaving the fabric of spirituality as experienced by patients who have undergone a coronary bypass surgery

When one is faced with a life-threatening event, spiritual issues become extremely important. The depth of one person's suffering is a unique experience. The relationship that developed between the interpretation of the answers of the coronary artery bypass patients and self-interpretation were the two directions in which this hermeneutic research moved forward within the hermeneutic circle. Central implications of the concept of spirituality emerging from this study are spirituality as meaning through gaining a new appreciation of life and health, spirituality as an inner strength through love and faith and in an ontological sense, spirituality as an inner strength through suffering and desire. Suffering invites one into the spiritual domain. Indeed, this concept raises important considerations for the development of caring knowledge about spirituality.

Fear and anxiety in patients awaiting coronary artery bypass grafting

OBJECTIVE

The purpose of this study was to identify the prevalence of fear and anxiety in patients awaiting coronary artery bypass grafting and the factors associated with high fear and high anxiety.

DESIGN

The survey included 240 patients placed on the waiting list for coronary artery bypass grafting at one hospital.

SUBJECTS

Two hundred and seven patients completed the questionnaire.

INSTRUMENTS

The Bypass Grafting Fear Scale, the State-Trait Anxiety Inventory, and the Hospital Anxiety and Depression Scale were used.

RESULTS

Half of the patients experienced low fear and anxiety. Twenty-five percent had high fear, but only 5% had high anxiety. Patients who felt high fear were mainly women, had no vocational education, were on sick leave, were depressed, had a tendency towards anxiety, and had a short wait for operation. Patients who displayed medium or high anxiety were mostly under 55 years of age and had depression, but only low or no pain.

CONCLUSIONS

The results facilitate better identification of predictors of high fear and anxiety as well as direct support and information for those patients.