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Chronic heart failure (CHF) is a progressive life-limiting condition that necessitates early implementation of advance care planning (ACP). However, patients and caregivers encounter emotional, informational, and cultural barriers to effective ACP engagement. This meta-synthesis consolidates qualitative evidence to deepen our understanding of ACP practices in CHF care.
This study aimed to explore experiences of CHF patients and their caregivers in ACP, which is defined as a proactive decision-making process to establish future treatment plans based on patients' values. The study also aimed to identify barriers and facilitators influencing ACP decisions and assess the impact of flexible, personalized ACP approaches on care quality.
Using qualitative meta-synthesis, we analyzed 10 qualitative studies on CHF patients' and caregivers' ACP experiences. Data were thematically synthesized to identify emotional, relational, and practical factors that influence engagement in ACP.
Three themes emerged: (1) heart failure patients and caregivers face difficulties in ACP (difficulties from patients, difficulties from the family, and difficulties from the society), (2) multidimensional drivers and impacts of ACP (advance care planning drivers, acceptance and implementation of ACP, emotions and effects of ACP), (3) flexible, personalized ACP delivers tangible benefits (timing and effectiveness of ACP discussions, patients and caregivers have personalized needs for ACP, and patients and caregivers affirm ACP benefits).
ACP plays a critical role in improving end-of-life care quality and reducing emotional and decision-making burdens on caregivers. Flexible and personalized ACP strategies supported by trained healthcare professionals more effectively meet the unique needs of patients and families. To overcome persistent barriers and promote broader ACP adoption, healthcare systems should prioritize provider communication training, ACP education, and support systems tailored to diverse cultural contexts.
Cardiovascular disease (CVD) is a leading cause of mortality and disability worldwide, posing significant challenges to the quality of healthcare services. Social Cognitive Theory (SCT) provides a framework for understanding individual behaviors and guides the development of intervention programs aimed at promoting health-enhancing behaviors.
To evaluate the effectiveness of interventions based on SCT in improving health outcomes among patients with CVD.
From the creation of the databases until September 2024, we searched six databases and manually searched the references included in the study. The outcomes included cardiovascular risk factors (weight, blood pressure, blood lipids), physical capacity (6-min walk test, physical activity, daily steps, exercise self-efficacy), psychological states (anxiety, depression), and health behaviors (self-management, self-efficacy, quality of life). The quality of randomized controlled trials was evaluated with the Cochrane RoB 2 tool, and quasi-experimental studies were assessed using the JBI critical appraisal tool.
A total of 10 studies, involving 1140 participants, were included in the review. Compared to conventional cardiovascular care, interventions based on SCT were able to lower systolic blood pressure (MD = −6.36; 95% CI [−11.30, −1.41]; p = 0.012), total cholesterol (MD = −0.29; 95% CI [−0.49, −0.09]; p = 0.004), and low-density lipoprotein levels (MD = −0.21; 95% CI [−0.38, −0.04]; p = 0.015) in CVD patients. They also increased the 6-min walk test distance (MD = 33.87, 95% CI [5.40, 62.34], p = 0.02) and daily steps (SMD = 0.77; 95% CI [0.46, 1.09]; p < 0.001), improved physical activity (SMD = 0.65; 95% CI [0.25, 1.06]; p = 0.002) and exercise self-efficacy (SMD = 1.23, 95% CI [0.23, 2.23], p = 0.016), and enhanced quality of life (SMD = 0.75, 95% CI [0.06, 1.43], p = 0.032).
Social cognitive theory-based interventions hold promise for improving health outcomes in patients with cardiovascular disease. This study provides further insights into the application of SCT in clinical practice. However, given the limited number of included studies and the potential risk of bias, further high-quality research is required to validate these findings.
The purpose of this study was to explore the relationship between symptom clusters and self-management among maintenance haemodialysis (MHD) patients.
MHD patients experience disease progression and multiple symptom burdens that severely impact quality of life, and self-management of symptoms may significantly improve patient-reported outcomes.
A cross-sectional study.
This cross-sectional descriptive study included 194 patients undergoing MHD. The patients were assessed using the Dialysis Symptom Index (DSI) and the Haemodialysis Self-Management Instrument (HD-SMI). We used descriptive analysis, exploratory factor analysis, Pearson's correlation analysis and linear regression analysis to examine (1) the level of individual self-management, (2) the presence of symptom clusters by symptom severity and (3) the correlation between symptom clusters and self-management behaviours. This study was conducted in accordance with the STROBE checklist.
The top five most severe symptoms among the patients were itching, feeling tired or lack of energy, difficulty sleeping, dry mouth and dry skin. We identified five groups of symptoms: (1) poor sleep, (2) neuromuscular, (3) gastrointestinal, (4) skin irritation and (5) psychological. In the present study, MHD patients reported low to moderate levels of self-management behaviours (50.84 ± 10.56), and low self-management ability was correlated with greater severity of the five symptom clusters (p < 0.01). Linear regression analysis revealed that all five symptom clusters were included in the regression equation, explaining 30% of the total variance in self-management skills among MHD patients.
Enhanced awareness of symptom clusters and comprehensive symptom management are necessary to improve patients' quality of life.
Nursing practices should incorporate comprehensive symptom assessments to help patients develop effective self-management strategies to improve quality of life.
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