Qualitative study to explore what patients with heart failure find significant during integrated palliative care sessions in a Danish clinic

OBJECTIVE

In the field of palliative care (PC) as it is integrated into heart failure (HF) treatment, it is essential to explore the patient experience and build on this knowledge for the further development of PC practice and policy. Based on an intervention study, this paper explores what patients with HF find significant in integrated sessions using a narrative S' approach.

DESIGN

We conducted a semistructured interview study with a qualitative analysis focused on meaning making. The study follows the guidelines of Consolidated Criteria for Reporting Qualitative Research.

PARTICIPANTS AND SETTING

The inclusion criteria for the PC intervention were (1) a new diagnosis of HF, (2) follow-up treatment at this local Danish HF clinic and (3) informed consent to participate in the integrated PC intervention. The only exclusion criterion was if the patient was already engaged in a PC programme. 20 patients agreed to participate in the intervention, and 12 of these completed the S' approach sessions and participated in this interview study.

RESULTS

Overall, the analysis showed that the integrated S' approach sessions were successful in joining an embodied patient perspective with a medical perspective. The thematic analysis resulted in three themes supporting the overall findings: sessions bring comfort, telling your story provides a sense of meaningfulness, and integrating perspectives of HF into everyday life.

CONCLUSION

The method using the S' approach in integrated PC and HF sessions was significant in various ways. First, patients experienced a calm and safe atmosphere and perceived that the nurse was truly interested in them. Second, the integrated sessions based on the S' approach were able to bring comfort to lived physical, psychosocial and existential issues. Last, it allowed patients to combine their embodied understanding of HF with a medical perspective, thereby finding meaning in the sense of how everything is connected.

Home care safety markers: a scoping review

Safety in home care is a new research frontier, and one in which demand for services continues to rise. A scoping review of the home care literature on chronic obstructive pulmonary disease and congestive heart failure was thus completed to identify safety markers that could serve to develop our understanding of safety in this sector. Results generated seven safety markers: (a) Home alone; (b) A fixed agenda in a foreign language; (c) Strangers in the home; (d) The butcher, the baker, the candlestick maker; (e) Medication mania; (f) Out of pocket: The cost of caring at home; and (g) My health for yours: Declining caregiver health.

Identifying treatment burden as an important concept for end of life care in those with advanced heart failure

PURPOSE OF REVIEW

The concept of treatment burden is receiving increasing attention and this review seeks to show that treatment burden is an important issue for end-of-life care in those with advanced heart failure.

RECENT FINDINGS

Review of the qualitative literature on patient experience of end-stage heart failure since the year 2000, including 2012, suggests that treatment burden, the work that patients have to do to manage their condition, is a readily identifiable concept in advanced heart failure. Treatment burden relates to four main areas of work, namely: coherence (sense making work) which refers to the work of developing an understanding of the illness (including its implications), treatment and management; appraisal, which refers to the work of judging, monitoring and adjusting treatments; relationship work which describes the effort put into engaging with others for support; and enacting work, that is the effort put into operationalizing treatments, which includes activities such as taking medications, attending appointments, enduring side effects of treatments and dealing with communication difficulties.

SUMMARY

Treatment burden has the potential to be an important barometer of quality of care from the patient perspective in advanced heart failure.

Examining markers of safety in homecare using the international classification for patient safety

BACKGROUND

Homecare is a growth enterprise. The nature of the care provided in the home is growing in complexity. This growth has necessitated both examination and generation of evidence around patient safety in homecare. The purpose of this paper is to examine the findings of a recent scoping review of the homecare literature 2004-2011 using the World Health Organization International Classification for Patient Safety (ICPS), which was developed for use across all care settings, and discuss the utility of the ICPS in the home setting. The scoping review focused on Chronic Obstructive Pulmonary Disease (COPD), and Congestive Heart Failure (CHF); two chronic illnesses commonly managed at home and that represent frequent hospital readmissions. The scoping review identified seven safety markers for homecare: Medication mania; Home alone; A fixed agenda in a foreign language; Strangers in the home; The butcher, the baker, the candlestick maker; Out of pocket: the cost of caring at home; and My health for yours: declining caregiver health.

METHODS

The safety markers from the scoping review were mapped to the 10 ICPS high-level classes that comprise 48 concepts and address the continuum of health care: Incident Type, Patient Outcomes, Patient Characteristics, Incident Characteristics, Contributing Factors/Hazards, Organizational Outcomes, Detection, Mitigating Factors, Ameliorating Actions, and Actions Taken to Reduce Risk.

RESULTS

Safety markers identified in the scoping review of the homecare literature mapped to three of the ten ICPS classes: Incident Characteristics, Contributing Factors, and Patient Outcomes.

CONCLUSION

The ICPS does have applicability to the homecare setting, however there were aspects of safety that were overlooked. A notable example is that the health of the caregiver is inextricably linked to the wellbeing of the patient within the homecare setting. The current concepts within the ICPS classes do not capture this, nor do they capture how care responsibilities are shared among patients, caregivers, and providers.

Informal caregivers' experiences of caring for patients with chronic heart failure: systematic review and metasynthesis of qualitative studies

BACKGROUND

Increasing evidence suggests that family support for patients with chronic heart failure (CHF) contributes greatly to the disease management of CHF. In addition, the quality of the CHF patient's close personal relationships can influence CHF outcomes. However, caregivers cannot provide care alone and need guidance, support, and skills to manage care that is often complex. In this article, we provide a review of studies that have explicitly investigated these issues of informal caregivers to CHF patients.

OBJECTIVE

The objective of this study was to explore informal caregivers' views and experiences of caring for patients with CHF.

METHODS

This is a systematic review and synthesis of qualitative studies describing informal caregivers' experiences in home-based care. Data sources were published literature written in English from electronic databases: PubMed, CINAHL (1982-2009), PsycINFO (1967-2009), EMBASE (1980-2009), and the Cochrane Library Database. Ten primary studies met the inclusion criteria.

RESULTS

A number of themes emerged. Five key themes were identified from synthesis of the studies: sharing of caring, suffering from anxiety, being isolated, enjoying a good relationship, and searching for support.

CONCLUSIONS

Caring for persons with CHF can affect the well-being of their informal caregivers, which may ultimately have consequences for the CHF patient's health. Further studies are needed to clarify these issues and to examine the role of informal caregivers in the management of CHF.