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Evaluation of a Coping Effectiveness Training intervention in patients with chronic heart failure: a randomized controlled trial
The Swedish Red Cross University College, Department of Nursing and Care. Karolinska Institutet, Department of Clinical Sciences Danderyd Hospital AB.ORCID iD: 0000-0002-1139-9489
Karolinska Institutet, Department of Clinical Sciences Danderyd Hospital AB.
The Swedish Red Cross University College, Department of Nursing and Care. 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 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 15, no 7, 537-548 p.Article in journal (Refereed) 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.

Place, publisher, year, edition, pages
2016. Vol. 15, no 7, 537-548 p.
Keyword [en]
Heart failure, intervention, randomized controlled trial, follow-up, sense of control, affect
National Category
Nursing Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:rkh:diva-1898DOI: 10.1177/1474515115625033PubMedID: 26733462OAI: oai:DiVA.org:rkh-1898DiVA: diva2:851008
Note

As manuscript in dissertation.

 

 

Available from: 2015-09-03 Created: 2015-09-02 Last updated: 2017-04-28Bibliographically approved
In thesis
1. Coping and emotional well-being in patients with chronic heart failure
Open this publication in new window or tab >>Coping and emotional well-being in patients with chronic heart failure
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
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.

Place, publisher, year, edition, pages
Stockholm: Karolinska Institutet, 2015. 82 p.
Keyword
Heart failure; Coping; Illness perception; Emotional well-being; Quality of life; Intervention; Randomized controlled trial
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:rkh:diva-1899 (URN)978-91-7676-001-7 (ISBN)
Public defence
2015-09-11, Sal Henry Dunant, Teknikringen 1, Stockholm, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2015-09-07 Created: 2015-09-03 Last updated: 2015-09-07Bibliographically approved

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