Ivynian, S, Newton, P & DiGiacomo, M 2020, 'Patient preferences for heart failure education and perceptions of patient-provider communication', Scandinavian Journal of Caring Sciences.View/Download from: Publisher's site
Objective: For people managing chronic illness, such as heart
failure, adequate health literacy is crucial to understand the
complex information that underpins self-care, yet evidence
suggests poor understanding in this patient population. To
better understand patients' heart failure comprehension and
why knowledge gaps may exist, this study sought to explore
perceptions of patient–provider communication and ascertain unmet educational needs and preferences.
Methods: Semi-structured in-depth interviews were conducted with 15 symptomatic inpatients with heart failure.
Data collection and analysis occurred simultaneously
until saturation was reached. Transcripts were analysed
using thematic analysis.
Results: Participants relied heavily on providers for HF
information and support, expressed numerous unmet
educational needs and had mixed feelings about quality
of communication. Participants expressed the need for
credible, tailored heart failure information that accounted
for comorbid conditions and preference for face-to-face
information delivery. Knowledge gaps included heart failure pharmacotherapy, symptom appraisal and management, cause and chronicity of heart failure, and a specific
action plan for heart failure symptom exacerbation.
Barriers to effective patient–provider communication
included providers using complex medical terminology,
lack of adequately detailed information, relationships that
did not foster open communication and participants'
Conclusion: Gaps in knowledge and poor communication
may indicate inadequate availability of multidisciplinary
heart failure management programmes and/or fidelity to
Practice implications: Evaluating heart failure management
programmes is important to ensure consistent delivery of
best-practice education and care. Nurses play a key role
in the delivery of patient-focused health information.
Ivynian, SE, Ferguson, C, Newton, PJ & DiGiacomo, M 2020, 'Factors influencing care-seeking delay or avoidance of heart failure management: A mixed-methods study.', International journal of nursing studies, vol. 108.View/Download from: Publisher's site
BACKGROUND:Delayed care-seeking for heart failure symptoms increases the risk of unplanned and frequent hospitalization. Presenting to hospital at a later stage when symptoms are severe requires more complex treatment, contributing to longer lengths of stay and higher risk of mortality. Patient-related factors such as knowledge have been highlighted as key contributors to care-seeking delay, yet little is known about how previous experiences within the healthcare setting, including relationships with providers, influence decisions to engage with health services when required. OBJECTIVE:To assess patient-related factors thought to impact care-seeking, and examine the role of previous healthcare experiences in decisions to seek or avoid professional care. DESIGN:Sequential mixed-methods study with a phenomenological approach. SETTINGS:A cardiology in-patient ward in a quaternary referral hospital in Sydney, Australia. PARTICIPANTS:A total of 72 symptomatic in-patients diagnosed with heart failure. METHODS:Self-efficacy, heart failure knowledge and health literacy were assessed quantitatively. Semi-structured, in-depth interviews were undertaken with a subset of participants to elicit previous healthcare experiences and their influence on seeking care when symptoms worsened. Qualitative data were analyzed using interpretative phenomenological analysis and interpreted in the context of quantitative findings. RESULTS:Three major themes were identified that impacted decisions to seek or avoid professional care: (i) preference for continuity; (ii) previous hospital experience and; (iii) patient-provider relationships. Avoidance of care-seeking was described, despite quantitative data reflecting high levels of self-efficacy, heart failure knowledge (12.3±1.9 out of 15), and above-average health literacy levels (75% adequate - 15% higher than average in heart failure). The qualitative and quantitative data together demonstrate that participants delayed seeking care for he...
Singh, GK, Ivynian, SE, Ferguson, C, Davidson, PM & Newton, PJ 2020, 'Palliative care in chronic heart failure: a theoretically guided, qualitative meta-synthesis of decision-making.', Heart failure reviews, vol. 25, no. 3, pp. 457-467.View/Download from: Publisher's site
International clinical practice guidelines recommend that patients with chronic heart failure receive timely and high-quality palliative care. However, integrating palliative care is highly variable and dependent on decision-making and care models. This meta-synthesis aimed to examine health care professionals' decision-making processes and explore factors impacting decisions to refer or deliver palliative care in chronic heart failure. The electronic databases SCOPUS, CINAHL, and Medline were searched. Included studies were those that reported health care professionals' perceptions of palliative care in chronic heart failure through qualitative data collection, were written in English, and were peer-reviewed articles. Included articles were analysed using Thomas and Harden's approach. The dual-process theory was used and applied a priori to organise the findings. The perception of palliative care as a transition and active treatment failure fit within the intuitive system of thinking in the dual-process theory. The theme that overlapped into both intuitive and analytical systems of thinking was acquiring patient and illness information themes reflecting the analytical system of thinking were professional role and experience, pre-existing decision pathways, and balancing viewpoints. This meta-synthesis identified factors influencing the decision-making process in referring patients with chronic heart failure to palliative care. The findings from this review highlight the need for further development of decision-making tools or facilitate guidelines to assist health care professionals' shared decision-making to improve patient outcomes.
Ivynian, SE, Ferguson, C & Davidson, PM 2019, 'Time to re-think the terminology of heart failure?', European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology, pp. 1474515119874538-1474515119874538.View/Download from: Publisher's site
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: 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: 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: 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.