Luckett, T, Phillips, J, Johnson, M, Garcia, M, Bhattarai, P, Carrieri-Kohlman, V, Hutchinson, A, Disler, RT, Currow, D, Agar, M, Ivynian, S, Chye, R, Newton, PJ & Davidson, PM 2017, 'Insights from Australians with respiratory disease living in the community with experience of self-managing through an emergency department 'near miss' for breathlessness: a strengths-based qualitative study.', BMJ Open, vol. 7, no. 12, pp. 1-11.View/Download from: UTS OPUS or Publisher's site
Breathlessness 'crises' in people with chronic respiratory conditions are a common precipitant for emergency department (ED) presentations, many of which might be avoided through improved self-management and support. This study sought insights from people with experience of ED 'near misses' where they considered going to the ED but successfully self-managed instead.A qualitative approach was used with a phenomenological orientation. Participants were eligible if they reported breathlessness on most days from a diagnosed respiratory condition and experience of ≥1 ED near miss. Recruitment was through respiratory support groups and pulmonary rehabilitation clinics. Semistructured interviews were conducted with each participant via telephone or face-to-face. Questions focused on ED-related decision-making, information finding, breathlessness management and support. This analysis used an integrative approach and independent coding by two researchers. Lazarus and Cohen's Transactional Model of Stress and Coping informed interpretive themes.Interviews were conducted with 20 participants, 15 of whom had chronic obstructive pulmonary disease. Nineteen interviews were conducted via telephone. Analysis identified important factors in avoiding ED presentation to include perceived control over breathlessness, self-efficacy in coping with a crisis and desire not to be hospitalised. Effective coping strategies included: taking a project management approach that involved goal setting, monitoring and risk management; managing the affective dimension of breathlessness separately from the sensory perceptual and building three-way partnerships with primary care and respiratory services.In addition to teaching non-pharmacological and pharmacological management of breathlessness, interventions should aim to develop patients' generic self-management skills. Interventions to improve self-efficacy should ensure this is substantiated by transfer of skills and support, including knowledge...
Ivynian, S, DiGiacomo, M & Newton, P 2015, 'Care-seeking decisions for worsening symptoms in heart failure: a qualitative metasynthesis', Heart Failure Reviews, vol. 20, no. 6, pp. 655-671.View/Download from: UTS OPUS or Publisher's site
Over 50% of heart failure (HF) patients delay seeking help for worsening symptoms until these reach acute levels and require emergency hospitalisation. This metasynthesis aimed to identify and explore factors influencing timely care-seeking in patients with HF.
Ivynian, S, Newton, P & DiGiacomo, M 2018, 'Care-seeking decisions in patients with heart failure: a matter of identity and previous healthcare experience', European Society of Cardiology: Heart Failure 2018, Vienna.
Ivynian, S, Newton, P & DiGiacomo, M 2018, 'Patient preferences for HF information delivery and perceptions of patient-provider communication', European Society of Cardiology Heart Failure 2018, Vienna.
McDonagh, J, Ferguson, C, Jha, S, Ivynian, S, Crossley, C, Montgomery, E, Hwang, C, Inglis, S, Singh, G, Davidson, P, Macdonald, P & Newton, P 2016, 'Frailty in hospitalized heart failure patients predicts death and rehospitalisation at 6 months', The Journal of frailty & aging, International Conference on Frailty & Sarcopenia Research, Philadelphia, USA.
Ivynian, S, DiGiacomo, M, Jha, S, Crossley, C & Newton, P 2015, 'Care-seeking decisions for worsening symptoms in heart failure: a qualitative metasynthesis', Heart Lung and Circulation, Cardiac Society of Australia and New Zealand, Elsevier, Melbourne, pp. 419-419.View/Download from: UTS OPUS or Publisher's site
Purpose: Over 50% of heart failure (HF) patients delay seeking help for worsening symptoms until these reach acute levels and require emergency hospitalisation. This metasynthesis aimed to identify and explore factors influencing timely care-seeking in patients with HF.
Methods: Electronic databases searched were Medline, EMBASE and CINAHL. Studies were included if they were peer reviewed journal articles written in English, and reported perspectives of HF patients following qualitative data collection and analysis. Forty articles underwent analysis following the approach of Thomas and Harden. Leventhal's self-regulatory model (SRM) was used to organise the literature.
Results: Much of the literature fit within the SRM, however this model did not account for all factors that influence patients' care-seeking for worsening symptoms. Factors not accounted for included patients' appraisals of previous care-seeking experiences, perceived system and provider barriers to accessing care, and the influence of external appraisals. When added to factors already represented in the model, such as misattribution of symptoms, not identifying with HF diagnosis, cognitive status, lack of understanding information provided, adaptation to symptoms, and emotional responses, a more comprehensive account of patients' decision-making was revealed.
Implications: This metasynthesis identified factors, as yet unaccounted for, in a prominent model, and has suggested a more comprehensive framework for addressing care-seeking in HF patients. This information can be used to tailor education, communication, and service initiatives to improve HF patients' responses to worsening symptoms.