Do Interventions Meet the Needs of Caregivers of Cardiac Patients?: A Scoping Review.

BACKGROUND: Interventions targeting the needs of caregivers of cardiac patients are few, and in most cases, no effect is found on caregivers' well-being. A closer look at the existing interventions will provide a solid foundation for future efforts to develop effective interventions targeted at caregivers of cardiac patients. OBJECTIVE: The study's objective was to scrutinize and discuss interventions targeting caregivers of cardiac patients and contribute to reflections that will improve future interventions. METHODS: Systematic scoping of the literature within the field was conducted through a literature search in PubMed, EMBASE, CINAHL, PsycINFO, and Cochrane Library from January 2011 to May 2022. The development of search terms and inclusion criteria was inspired by the Patient problem/population, Intervention, Comparison/Control, and Outcome approach, and the Medical Research Council framework for developing and evaluating complex interventions served as the underlying basis for the analysis. RESULTS: Eleven articles were included. The interventions reported in the articles were generally not systematically developed and did not include field-specific, methodological, and theoretical reflections. Furthermore, the development process behind the studies seemed not to be transparent. CONCLUSIONS: Lack of systematic methodology and methodological transparency in the reviewed studies hinders further testing of interventions and might explain lack of evidence for effective interventions within the field. More systematic, needs-based, and well-documented interventions targeting caregivers of various kinds of cardiac patients are needed to develop the field to the benefit of caregivers, patients, and society.

The Danish landscape of providing support for caregivers of people with potentially life-threatening disease: A cross-sectional study among representatives of health services in Danish municipalities and hospitals.

AIMS: (a) To investigate support for caregivers of people diagnosed with stroke, cancer, chronic obstructive pulmonary disease (COPD), dementia, or heart disease provided across healthcare settings in Denmark; (b) to assess differences in caregiver support across diagnoses and settings. METHODS: A cross-sectional nationwide survey among professionals representing healthcare settings at municipalities (n = 479) and hospital wards and outpatient clinics (n = 425). The survey assessed identification of caregivers and support initiatives. RESULTS: The response rate was 81% for municipalities and 49% for hospitals. Identification of caregivers was frequent in dementia care (81% and 100%) and less frequent in COPD care (58% and 64%) in municipalities and hospitals, respectively. Caregiver support differed significantly across diagnoses within municipalities (p = 0.009) and hospitals (p < 0.001). Systematic identification of vulnerable caregivers was <25% for all diagnoses except dementia. The most common support initiatives involving caregivers were primarily aimed at the ill person and included guidance about the disease and consequences for everyday life and lifestyle changes. Caregivers were least involved in support initiatives addressing physical training, work retention, sexuality, or cohabitation. CONCLUSIONS: Disparities and significant differences across diagnoses exist in the identification of caregivers and the provision of support initiatives. Support initiatives involving caregivers primarily targeted patients. Future studies should investigate how caregivers' needs can be met across different diagnoses and healthcare settings and investigate potential changes in caregivers' needs during disease trajectories. In clinical practice, identification of vulnerable caregivers should be a major focus, and disease-specific clinical guidelines may be required to ensure sufficient support for caregivers.

Dynamics of a specialized and complex health care system: Exploring general practitioners' management of multimorbidity.

OBJECTIVE: To explore general practitioners' (GPs') experiences of cooperation with hospital-based physicians regarding multimorbid patients and to identify challenges as well as strategies in managing such challenges.Study setting: Three medical practices in a provincial town in Denmark. STUDY DESIGN: A qualitative methodological design was used with explorative data collection among GPs.Data collection/Extraction methods: Participant observation, qualitative interviews and a focus group interview were conducted. Interpretive description was used as the analytical framework.Principal findings: The GPs appreciated cooperating with physicians in optimizing treatment of multimorbid patients. However, three main challenges were experienced: insufficient communication and coordination; unclear divisions of roles and responsibilities; and differences in the way of approaching patients. The GPs navigated these challenges and complexities by taking advantage of their personal relationships and by developing creative and patient-centred ad hoc solutions to difficulties in cross-sectorial cooperation. A hospital initiative to support care for multimorbid patients has not been adopted by the GPs as a preferred strategy. CONCLUSIONS: The structures of the health care system severely challenged cooperation regarding multimorbid patients; nevertheless, these GPs were aware of the advantages of cooperation, and their mainstay strategy in this involved personalized solutions and flexibility.

The national implementation of 'Proactive Health Support' in Denmark since 2017: Expectations and challenges for the telephone-based self-management program.

In Denmark, as in many other Western countries, a small group of people are major hospital users and account for a large proportion of health care spending. Proactive Health Support (PaHS) is the first national Danish program that aims to reduce health care consumption targeting people at risk of becoming major users of health services. PaHS was part of the government's The sooner-the better national health policy, which includes a focus on policy programs targeting the weakest and most complex chronic patients at risk of high health care consumption. PaHS is a telephone-based self-management support program that uses a prediction model to identify people at high risk of acute hospital admissions. Reducing preventable hospital admissions and enhancing quality of life are central policy goals. The Danish policy was inspired by a Swedish policy program, and PaHS has been implemented based on policy transfer with political expectations that the Swedish results can be replicated in Denmark. The effects of PaHS are currently under study, and time will show whether expectations can be met. This paper discusses institutional conditions and expectations related to replicating a policy program and its outcomes. In addition, it highlights implementation issues that may affect the success of the policy program.

Proactive health support (PaHS) - telephone-based self-management support for persons at risk of hospital admission: Study protocol for a randomized controlled trial.

BACKGROUND: A small proportion of patients account for most of the healthcare costs. Previous studies of supportive interventions have several methodological limitations and results are mixed. This article describes the protocol for Proactive Health Support: a national randomized controlled trial of telephone-based self-management support (ClinicalTrials.gov, NCT03628469). The main aim of the intervention is to reduce hospital admissions and improve quality of life at six months. METHODS: A sample size of 4400 is needed and individuals with the highest risk of hospital admission in Denmark are invited by electronic communication and telephone to participate in a 1:1 randomized controlled trial. The intervention group receives one face-to-face start-up session followed by telephone sessions about individual goals regarding participants' knowledge, coping and need of healthcare. Quality of life was assessed with the mental health composite score of the SF-36v2 questionnaire. Primary analyses are done using the intention-to-treat principle. DISCUSSION: The trial has been approved by The Regional Committee on Health Research Ethics (SJ-677). Intervention nurses do not assume clinical responsibility for the participants and the intervention is an addition to the general healthcare services. The intervention is complex due to challenging skills and behaviors required by nurses, individual tailoring of the intervention, and interacting intervention components. The study therefore includes process evaluation. The research program comprises: 1. Development initiation, 2. Intervention effect, 3. Cost-effectiveness, 4. Organizational implementation, and 5. Participants' experiences. Inclusion to the trial began April 9th, 2018, was completed July 1st, 2019 and follow-up will be completed February 1st, 2020.

Volunteering to Care for People with Severe Mental Illness: A Qualitative Study of the Significance of Professional and Private Life Experience.

Challenges in recruiting volunteers encountered by psychiatric services are barely elucidated despite a general societal increase in volunteering. The aim of the study was to explore the significance of professional and private life experiences in willingness to volunteer to care for people with severe mental illness. Focus group interviews with volunteers in the Community Family Programme was conducted, followed by thematic analysis. All interviewees had professional and/or private experience of SMI, which had a major influence on their initial willingness to volunteer. Volunteering was an opportunity to pass on their experiences and to care for SMI people in ways that were not possible in their professions. The interviewees did not distinguish between the influences of professional and/or private life experiences on their willingness to volunteer. The study demonstrates the importance of professional and/or private life experiences in initial considerations about volunteering for mental health care. The consequences for recruitment practices are discussed.

Resistance to change: Role of relationship and communal coping for coronary heart disease patients and their partners in making lifestyle changes.

BACKGROUND: Lifestyle behaviours are important risk factors for coronary heart disease (CHD) and, hence, motivation for lifestyle changes is suggested to be a key factor in the success of cardiac rehabilitation and secondary prevention programmes. The motivation for changing lifestyle among people with CHD may be influenced by those with whom they have long-term, intimate relationships. AIMS: This study explores the role of the relationship between people with CHD and those closest to them in making lifestyle changes. This includes investigating if patients and partners experience autonomy, competence, and relatedness, and what role communal, i.e. relationship-centred coping serves in relation to patients' health behaviour. METHODS: The study is based on semi-structured, in-depth interviews with 10 couples; people who have experienced acute coronary syndrome, and their partners. Participants had diverse histories of disease and social backgrounds. A three-stage interview process was undertaken including focus group interviews, couple interviews and individual interviews. A thematic analysis, inspired by the self-determination theory and the interdependence theory, was conducted. RESULTS: Communal coping is evident in various forms, and at different levels, among people with CHD and their partners. Satisfaction with new lifestyle, ownership of change, confidence in ability to change, and emotional distress are all factors that affect how couples deal with lifestyle changes in the aftermath of CHD. CONCLUSIONS: Rehabilitation efforts, aimed at lifestyle changes, need to address each individual, as well as the dyadic interaction within couples. Incorporating a dyadic perspective in the rehabilitation process may lead to a reduction in motivational barriers to lifestyle changes.

Monitoring the Normal Body: Ideals and Practices among Normal-Weight and Moderately Overweight People.

INTRODUCTION: An extensive body of literature is concerned with obese people, risk, and weight management. However, little is known about weight management among people not belonging to the extreme BMI categories. Management of weight among normal-weight and moderately overweight individuals provides us with knowledge about how to prevent future overweight or obesity. This paper investigates body size ideals and monitoring practices among normal-weight and moderately overweight people. METHODS: The study is based on in-depth interviews combined with observations. 24 participants were recruited by strategic sampling based on self-reported BMI 18.5-29.9 kg/m2 and socio-demographic factors. Inductive analysis was conducted. RESULTS: Normal-weight and moderately overweight people have clear ideals for their body size. Despite being normal weight or close to this, they construct a variety of practices for monitoring their bodies based on different kinds of calculations of weight and body size, observations of body shape, and measurements of bodily firmness. Biometric measurements are familiar to them as are health authorities' recommendations. Despite not belonging to an extreme BMI category, they translate such measurements and recommendations in meaningful ways to fit their everyday life. CONCLUSIONS: Normal-weight and moderately overweight people are concerned with their body size and continuously monitor it. Future health promotion work should consider the kind of practices already established in daily life when recommending ways of conducting body management.

Are hospitals also for relatives? A survey of hospitals' activities regarding relatives of cardiac patients.

AIM: Patients and their close relatives both feel the burden of cardiovascular disease. Relatives of heart patients experience lower quality of life and increased mortality than the general population and relatives of patients with other diseases. Nevertheless, knowledge on health services aimed at relatives of patients with cardiac diseases is sparse. This study aimed to survey the prevalence of health services for relatives of cardiac patients in Denmark. METHODS: We surveyed activities offered by Danish hospitals to the relatives of cardiac patients. Data were obtained from an Internet-based survey and 50 of 55 invited hospital departments participated. RESULTS: Almost all departments offer activities to relatives of cardiac patients, but only one-quarter have activities specifically aimed at supporting relatives. Large departments offer activities for relatives more often than smaller departments. Participation rates for relatives are generally low, and the departments experience numerous barriers in providing activities for relatives of heart patients. CONCLUSIONS: Danish hospitals focus very little on relatives of cardiac patients, and this seems to be due to several factors, including lack of resources, lack of interest and knowledge among staff, and practical and psychological barriers among patients and relatives. More research is needed on health services concerning relatives of cardiac patients, regarding both the prevalence of activities and barriers to these.

Health service interventions targeting relatives of heart patients: a review of the literature.

AIMS: Relatives of heart patients experience anxiety, uncertainty, and low quality of life, and the hospitalization of a heart patient is associated with increased risk of death for the partner. Relatives' physical and mental problems may be rectified by activities established by the health services to support relatives and to enable them to handle the situation. This study systematically reviewed the literature on the latest health service interventions targeting relatives of heart patients. METHODS: The literature about interventions targeting relatives of heart patients has been systematically reviewed to clarify what the health services do for relatives of heart patients and to assess the effects of interventions. We searched Medline, EMBASE, PsycINFO, CINAHL database, CSA and the Cochrane Library from January 2000 to March 2006. RESULTS: Only six scientific articles reported on interventions testing health service activities for relatives of heart patients, and one literature review scrutinized earlier studies within the field. All the interventions indicate positive effects on patients' and/or relatives' health and well-being, in accordance with nurses' assessments. Nevertheless, the few studies and their questionable quality means that full evidence on the effects of the interventions is lacking. CONCLUSIONS: Future research should clarify the evidence for health service interventions and draw up guidelines for activities for the relatives of heart patients.