Uncertainty in illness among patients with chronic heart failure is less in person-centred care than in usual care
Uncertainty in illness among patients with chronic heart failure is less in person-centred care than in usual care
复制标题
DOI：
10.1177/1474515112472270
复制
发表时间：
2013-12-01
影响因子：
2.9
通讯作者：
Ekman, Inger
中科院分区：
文献类型：
--
作者：
Dudas, Kerstin;Olsson, Lars-Eric;Ekman, Inger
背景：许多慢性心力衰竭（CHF）患者在治疗和疾病特征方面存在不确定性。以人为中心的护理（PCC）强调病人参与护理。我们之前已经证明PCC改善了CHF患者的结局，如住院时间和日常生活活动。PCC的影响，对自我报告的不确定性，在疾病中住院治疗的CHF患者仍是unknowed.Aim：为了评估PCC是否与较少的自我报告的不确定性，在疾病中与常规护理相比，住院治疗的CHF恶化的患者。方法：使用一个控制前后设计，符合条件的CHF患者被分配到一个常规护理组或PCC干预组。在出院时使用心血管人群量表（CPS）评估患者报告的疾病不确定性。CPS包括两个领域：1）模糊性（关于疾病的严重程度）;和2）复杂性（治疗和护理系统）。结果：248例患者被纳入研究; 123例在常规护理组和125例在PCC干预。PCC组在CPS领域复杂性（M=15.2，SD=4.7 vs. M=16.8，SD=4.7; p=0.020）和模糊性（M=27.8，SD=6.6 vs. M=29.8，SD=6.9; p=0.041）方面优于常规治疗组。结合早期发现的住院时间缩短和日常生活活动改善，这表明PCC应成为CHF恶化患者住院治疗的标准方法。
Background:Many patients with chronic heart failure (CHF) experience uncertainty regarding the treatment and characteristics of their illness. Person-centred care (PCC) emphasizes patient involvement in care. We have previously shown that PCC improved outcomes such as length of hospital stay and activities of daily living in patients with CHF. The impact of PCC on self-reported uncertainty in illness among patients hospitalized for CHF is still unknown.Aim:To evaluate whether PCC is associated with less self-reported uncertainty in illness compared with usual care in patients hospitalized for worsening CHF.Methods:Using a controlled before-and-after design, eligible CHF patients were assigned to either a usual care group or a PCC intervention group. Patient-reported uncertainty in illness was assessed at hospital discharge with the Cardiovascular Population Scale (CPS). The CPS consists of two domains: 1) Ambiguity (about illness severity); and 2) Complexity (of treatment and system of care).Results:Two hundred and forty-eight patients were included in the study; 123 in the usual care group and 125 in the PCC intervention. The PCC group had better scores than the usual care group in the CPS domains complexity (M=15.2, SD=4.7 vs. M=16.8, SD=4.7; p=0.020) and ambiguity (M=27.8, SD=6.6 vs. M=29.8, SD=6.9; p=0.041).Conclusion:Patients with CHF were less uncertain in their illness after PCC, which may help to equip and empower patients to manage their illness. Together with earlier findings of shortened hospital stay and improved activities of daily living, this indicates that PCC should be a standard approach for hospital care of patients with worsening CHF.