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Evaluation of a Coping Effectiveness Training intervention in patients with chronic heart failure: a randomized controlled trial
Röda Korsets Högskola, Avdelningen Vård och Omvårdnad. Karolinska Institutet, Department of Clinical Sciences Danderyd Hospital AB.ORCID-id: 0000-0002-1139-9489
Karolinska Institutet, Department of Clinical Sciences Danderyd Hospital AB.
Röda Korsets Högskola, Avdelningen Vård och Omvårdnad. Karolinska Institutet, Department of Clinical Sciences Danderyd Hospital AB.ORCID-id: 0000-0003-1445-900X
Public Healthcare Services Committee Administration, Stockholm County Counsil; Karolinska Institutet, Department of Learning, Informatics, Management and Ethics, Medical Management Centre.
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2016 (Engelska)Ingår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 15, nr 7, s. 537-548Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

BACKGROUND: Impaired emotional well-being has detrimental effects on health outcomes in patients with chronic heart failure (CHF).AIMS:To evaluate a nurse-led Coping Effectiveness Training (CET) group intervention for patients with CHF. It was hypothesized that CET would increase emotional well-being (primary outcome) and health-related quality (HRQoL) of life and improve clinical outcomes. Furthermore, changes in appraisal and coping as mediators of the intervention effect were examined.

METHODS: Participants were randomized to either control group (n=51) receiving standard health care or CET intervention group (n=52). Self-assessments of positive affect, negative affect, depression, anxiety, HRQoL, illness perception, coping strategies and social support were performed pre- and post-intervention and after six weeks, six months and 12 months. Time to death and hospitalizations were measured during the entire follow-up (median 35 months, interquartile range 11 months).

RESULTS: No significant improvements for emotional well-being and HRQoL in the intervention group compared with the control group were found. After excluding patients with clinical anxiety and depression at baseline the intervention group had significantly lower negative affect (p = 0.022). There were no significant differences regarding cardiovascular events between the groups. The intervention group had greater sense of control over their illness in the short-term (p = 0.036).

CONCLUSION: CET intervention was found to increase sense of control over the illness in the short term. Psychosocial support programmes, like CET, for patients with CHF is currently lacking evidence for implementing in clinical practice. However, the results provide a basis for future studies with a modified CET intervention design and increased study size.

Ort, förlag, år, upplaga, sidor
2016. Vol. 15, nr 7, s. 537-548
Nyckelord [en]
Heart failure, intervention, randomized controlled trial, follow-up, sense of control, affect
Nationell ämneskategori
Omvårdnad Kardiologi
Identifikatorer
URN: urn:nbn:se:rkh:diva-1898DOI: 10.1177/1474515115625033PubMedID: 26733462OAI: oai:DiVA.org:rkh-1898DiVA, id: diva2:851008
Anmärkning

As manuscript in dissertation.

 

 

Tillgänglig från: 2015-09-03 Skapad: 2015-09-02 Senast uppdaterad: 2019-08-30Bibliografiskt granskad
Ingår i avhandling
1. Coping and emotional well-being in patients with chronic heart failure
Öppna denna publikation i ny flik eller fönster >>Coping and emotional well-being in patients with chronic heart failure
2015 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Background: Chronic heart failure (CHF) is a serious illness, with a profound impact on the patient. Poor health-related quality of life (HRQoL) as well as anxiety and depression are prevalent in CHF and predict mortality and rehospitalization, yet, psychosocial factors are infrequently treated and cared for.

Aim: To gather scientific evidence on illness perception and coping strategies to predict emotional well-being in patients with CHF and to establish a measurement model of coping strategies. Furthermore, to evaluate a nurse-led psychoeducational intervention, Coping Effectiveness Training (CET) adapted for patients with CHF.

Methods: Studies I-III were cross sectional. Study IV was a randomized controlled trial aimed to improve emotional well-being (one-year follow-up). All studies used patient reported outcome measures and clinical data via medical journals.

Results: Younger age and male gender were associated with higher levels of alcohol usage and/or drugs to cope, p < 0.01. Poor sense of coherence was associated with maladaptive coping (I). A four factorial model of Brief COPE displayed the best psychometric properties (II). Avoidant coping influenced negative affect (NA) (I), worse HRQoL (II) and greater anxiety and depression (III). CET (IV) improved personal control in the intervention group (IG) compared to the control group (CG), p = 0.036. Improved scores for the IG were detected in emotional well-being and HRQoL, p = ns. The IG demonstrated reduced NA, p = 0.022, excluding cases with clinical anxiety and depression. Time to cardiovascular readmission or death was non-significantly lower in the IG vs the CG (Hazard ratio 0.58 [0.29-1.18]) adjusted p = 0.135.

Conclusions: Personal resources seemed to influence the coping strategies used by patients with CHF. Avoidant coping had an adverse influence on emotional wellbeing and illness perception in CHF. The perceived sense of control and illness burden were of importance for emotional well-being. A CET intervention for patients with CHF increased sense of control over the illness. CET also reduced NA in patients with no or mild symptoms of anxiety and depression.

Ort, förlag, år, upplaga, sidor
Stockholm: Karolinska Institutet, 2015. s. 82
Nyckelord
Heart failure; Coping; Illness perception; Emotional well-being; Quality of life; Intervention; Randomized controlled trial
Nationell ämneskategori
Medicin och hälsovetenskap
Identifikatorer
urn:nbn:se:rkh:diva-1899 (URN)978-91-7676-001-7 (ISBN)
Disputation
2015-09-11, Sal Henry Dunant, Teknikringen 1, Stockholm, 09:00 (Svenska)
Opponent
Handledare
Tillgänglig från: 2015-09-07 Skapad: 2015-09-03 Senast uppdaterad: 2015-09-07Bibliografiskt granskad

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Nahlen Bose, CatarinaBjörling, GunillaSaboonchi, Fredrik

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European Journal of Cardiovascular Nursing
OmvårdnadKardiologi

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