Feasibility of a group-based self-management program among congestive heart failure patients

doi:10.1016/j.hrtlng.2009.01.007

Heart & Lung

Volume 38, Issue 6, November–December 2009, Pages 499-512

https://doi.org/10.1016/j.hrtlng.2009.01.007 Get rights and content

Objective

This study assessed the feasibility of the Chronic Disease Self-Management Program (CDSMP) among patients with congestive heart failure (CHF). The program emphasizes patients' central role and responsibility in managing their illness.

Methods

Patients were randomly assigned to the program, which was led by a cardiac nurse specialist and a CHF patient. Data on performance according to protocol, adherence, and opinion about the program were collected among 186 patients and 18 leaders.

Results

Eighty percent of the group sessions were carried out largely according to protocol. Three fourths of the patients attended at least 4 of the 6 sessions. Female sex and lower New York Heart Association classification predicted good attendance.

Conclusion

Directly after the program and at 12-month follow-up, approximately three fourths of the patients stated that they had benefited from the program. Recommendations mainly concerned spending more time on several program topics and specifying patient-selection criteria in more detail. The program was considered feasible.

Section snippets

Participants

The process evaluation was performed among 186 CHF patients (who were assigned to 1 of the 21 CDSMP classes) and 18 leaders (9 professional leaders and 9 peer leaders) who conducted the program during the intervention period after they had been trained for 4 days in the CDSMP protocol.⁴³ The professional leaders were cardiac nurse specialists. They conducted the CDSMP classes in combination with their usual work in the hospital. The peer leaders were CHF patients who had New York Heart

Participant characteristics

Mean patient age (n = 186) was 66.6 years (SD 11.0; range 29 to 87). The majority of patients were men (76% [n = 141]), did not live alone (67%), were not employed (91%), and had a secondary (vocational) education (64%). Approximately two thirds of patients (65%) experienced NYHA class II symptoms (slight physical limitation). The majority of the professional leaders were female (78% [n = 7]), and all peer leaders were male; mean ages were 45.6 (SD 5.2) and 58.1 (SD 10.5) years, respectively.

Discussion

This evaluation study showed that the program was considered feasible according to both patients and leaders. Feasibility was based on (1) positive outcomes from the leaders regarding practicability of the CDSMP protocol, (2) positive outcomes regarding patients' attendance and adherence (ie, overall adherence to the program and homework assignments) according to both patients and leaders; and (3) positive opinions about the CDSMP from both patients and leaders. Patients and leaders were asked

Limitations

Regarding the original intervention, we made one important adaptation in our choice of who lead the program: The CDSMP classes in our study were led by teams consisting of a cardiac nurse specialist (professional leader) and a CHF patient (peer leader) instead of 2 trained volunteer lay leaders. CHF patients were included in the team to improve modeling in the CDSMP classes. Including CHF peer leaders may have affected the program's continuity negatively in terms of attendance at the program

Recommendations

Based on the results of this study, we can make 4 recommendations. First, we recommend reconsidering the sequence of the activities in session 4—“advance directives for health care,” “communication skills,” and “problem-solving”—and simplifying the contents of these activities. In more than half of the classes, participants had difficulties dealing with these topics or even lost motivation to attend these activities. By 2006, some small revisions had already been made to the original CDSMP

Comments

This study reported on the feasibility of the CDSMP8, 29, 30, 31 among CHF patients with NYHA class II and III symptoms. The program emphasizes patients' central role and responsibility in managing their own illness and teaches patients to become active self-managers, which is crucial for CHF self-management. Based on the results of our study, this comprehensive group-based program seems applicable to a homogeneous patient group of CHF patients with NYHA class II and III symptoms in The

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Citation Excerpt :
In the evaluation of the TPE programmes and outcomes, clinical status after education was taken into account by only four studies [25,27,32,40]. Reduction in mortality after education was cited by five studies [26–28,32,34], patient adherence to the programme was cited by four studies [23,29,39,40], patient satisfaction with the TPE programme was cited by two studies [39,40] and the cost-effectiveness of TPE was cited by just by one study [32]. Concerning reinforcement interventions, only three studies mentioned telephone calls [24,30,41], and one [41] mentioned booster sessions or recalls.
Therapeutic patient education programmes on heart failure have been widely proposed for many years for heart failure patients, but their efficiency remains questionable, partly because most articles lack a precise programme description, which makes comparative analysis of the studies difficult. To analyse the degree of precision in describing therapeutic patient education programmes in recent randomized controlled trials. Three major recent recommendations on therapeutic patient education in heart failure inspired us to compile a list of 23 relevant items that an ‘ideal’ description of a therapeutic patient education programme should contain. To discover the extent to which recent studies into therapeutic patient education in heart failure included these items, we analysed 19 randomized controlled trials among 448 articles published in this field from 2005 to 2012. The major elements required to describe a therapeutic patient education programme were present, but some other very important pieces of information were missing in most of the studies we analysed: the patient's educational needs, health literacy, projects, expectations regarding therapeutic patient education and psychosocial status; the educational methodology used; outcomes evaluation; and follow-up strategies. Research into how therapeutic patient education can help heart failure patients will be improved if more precise descriptions of patients, educational methodology and evaluation protocols are given by authors, ideally in a standardized format.
L’efficience des programmes d’éducation thérapeutique (ETP) dans l’insuffisance cardiaque (IC) est encore discutée ; la description insuffisamment précise des programmes dans la plupart des articles rend plus difficile l’analyse comparative des études. Analyser le degré de précision dans la description des programmes d’ETP issus d’études randomisées récentes. En s’inspirant de trois recommandations internationales récentes sur l’ETP dans l’IC, nous avons constitué une liste de 23 critères de précision qu’une description idéale d’un programme d’ETP devrait comporter. Pour vérifier si ces critères étaient présents dans la littérature récente (2005–2012), nous avons analysé 19 études randomisées contrôlées portant sur l’ETP dans l’IC. Bien que la plupart des éléments descriptifs des programmes d’ETP soient présents, nous avons repéré des lacunes d’information dans les études concernant les besoins d’éducation des patients, leur litéracie en santé, leurs attentes vis-à-vis de l’ETP, leurs projets et leur statut psycho social. La description de la méthodologie éducative, comme celle de l’évaluation des résultats font souvent défaut, ainsi que les stratégies de suivi. La recherche sur l’efficience de l’ETP dans l’IC pourrait être améliorée si la description des patients, des méthodologies pédagogiques, d’évaluation et de suivi utilisées étaient décrites de façon plus complète et plus précise. Une standardisation des critères de précision des études pourrait s’avérer utile.
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2010, Patient Education and Counseling
The Chronic Disease Self-Management Programme (CDSMP)was recently evaluated among patients with congestive heart failure (CHF) in a randomized controlled trial (n = 317) with twelve months of follow-up after the start of the programme. That trial demonstrated short-term improvements in cardiac-specific quality of life. The current study assessed which of the patients participating in this trial benefited most from the CDSMP with respect to cardiac-specific quality of life.
Subgroup analyses were conducted using mixed-effects linear regression models to assess the relationship between patient characteristics and the effects of the CDSMP on cardiac-specific quality of life.
In the short term, patients with better cognitive status benefited more from the CDSMP than their poorer functioning counterparts. In addition, lower educated patients benefited more from the CDSMP than their higher educated counterparts during total follow-up.
Subgroup effects were found for cognitive status and educational level. Future research should be performed to validate current findings and further explore the conditions under which CHF patients may benefit more from the programme.
These results indicate that lower educated patients, in particular, should be encouraged to participate in the CDSMP. In addition, healthcare practitioners are recommended to take into account potential cognitive impairments of patients.
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Issues in cardiovascular nursingFeasibility of a group-based self-management program among congestive heart failure patients

Objective

Methods

Results

Conclusion

Section snippets

Participants

Participant characteristics

Discussion

Limitations

Recommendations

Comments

Heart Lung Circ

Clin Geriatr Med

Heart Lung

Int J Cardiol

Patient Educ Couns

Appl Nurs Res

Patient Educ Couns

J Card Fail

Patient Educ Couns

Patient Educ Couns

Patient Educ Couns

Nurs Clin North Am

Soc Sci Med

Heart Lung

Heart failure and the aging population: an increasing burden in the 21st century?

Heart

Epidemiology of heart failure in a community-based study of subjects aged ≥57 years: incidence and long-term survival

Eur J Heart Fail

The prognosis of heart failure in the general population: the Rotterdam Study

Eur Heart J

Behavioral contributions to rehabilitation and childhood asthma

Rehabil Lit

Self-management education: history, definition, outcomes, and mechanisms

Ann Behav Med

A situation-specific theory of heart failure self-care

J Cardiovasc Nurs

Conceptualizing self-care in heart failure: a life course model of patient characteristics

J Cardiovasc Nurs

Outcome measurement: self-management in heart failure

J Cardiovasc Nurs

Development and testing of the European Heart Failure Self-Care Behaviour Scale

Eur J Heart Fail

Randomized, controlled trial of long-term moderate exercise training in chronic heart failure: effects on functional capacity, quality of life, and clinical outcome

Circulation

Living a healthy life with chronic conditions: self-management of heart disease, arthritis, diabetes, asthma, bronchitis, emphysema and others

Issues in cardiovascular nursing
Feasibility of a group-based self-management program among congestive heart failure patients