Care-seeking decisions for worsening symptoms in heart failure: a qualitative metasynthesis
Care-seeking decisions for worsening symptoms in heart failure: a qualitative metasynthesis
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DOI：
10.1007/s10741-015-9511-x
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发表时间：
2015-11-01
影响因子：
4.6
通讯作者：
Newton, P. J.
中科院分区：
文献类型：
--
作者：
Ivynian, S. E.;DiGiacomo, M.;Newton, P. J.
超过50%的心力衰竭（HF）患者延迟寻求症状恶化的帮助，直到这些症状达到急性水平并需要紧急住院治疗。本论文旨在探讨影响心力衰竭患者及时就医的因素。检索的电子数据库包括MEDLINE、Embase和CINAHL。如果研究是同行评议的期刊文章，用英语撰写，并在定性数据收集和分析后报告HF患者的观点，则纳入研究。按照托马斯和哈登的方法对40篇文章进行了分析。Leventhal的自我调节模型（SRM）被用来组织文献。大部分文献符合SRM;然而，该模型并未考虑影响患者因症状恶化而寻求护理的所有因素。未考虑的因素包括患者对既往就医经历的评价、感知的系统和提供者获得护理的障碍以及外部评价的影响。当添加到模型中已经表示的因素，如症状的错误归因，不确定HF诊断，认知状态，缺乏理解所提供的信息，适应症状和情绪反应，更全面的说明患者的决策被揭示。这个元分析在一个突出的模型中确定了尚未解释的因素，并提出了一个更全面的框架来解决HF患者的就医问题。这些信息可用于定制教育，沟通和服务计划，以改善HF患者对症状恶化的反应，并针对那些最有延迟风险的患者。
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. 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. Much of the literature fits 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. 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 and target those most at risk of delay.