Patients, Health Care Providers Prioritize Heart Failure Education Differently

Results of a recent study show that diet management education appeared more important to health care providers than it did to patients with heart failure, according to a study out of South Korea published in PLoS One.

There is an urgent need within the heart failure space to provide comprehensive patient education so they understand the ongoing needs of their disease and can properly monitor their condition. However, most previous studies have extrapolated patient education needs based on the opinions of health care providers. The 2 need to be reconciled.

“Patient-centered education is a partnership among patients, families, and healthcare providers, and it can promote patient satisfaction with education and successful implementation, and further improve disease and health outcomes,” noted the authors.

After recruiting 100 patients and 20 health care providers from cardiovascular outpatient clinics at tertiary medical centers in the cities of Seoul and Suwon in South Korea, the investigators collected data between June and October 2017. Included patients had to have an official diagnosis of heart failure and the health care providers (nurses, physicians) needed more than 5 years of clinical experience at the patients’ cardiovascular clinics.

A majority of participants in both groups were women—58% of patients, 75% of health care providers—but the patients were almost twice as old (72.15 vs 36.8 years). More than half of the patients (51%) reported New York Heart Association (NYHA) functional class III-IV disease, with the rest (49%) reporting NYHA class I-II disease.

Out of a possible high score of 5, patients came in slightly below health care providers in total mean score of learning needs: 3.76 vs 3.98.

Despite both groups ranking the topics of “medications” and “signs and symptoms” as their top 2 educational needs—with mean (SD) scores of 4.06 (1.09) and 4.04 (1.01), respectively—wide variation was seen in the scores assigned to “diet”: health care providers gave this topic a mean score of 4.18 (0.59) compared with 3.62 (0.95) from patients (P = .001). Psychological information, meanwhile, came in at the bottom for both: 3.49 (1.02) for patients and 3.60 (0.99) for health care providers.

The Heart Failure Patients’ Learning Needs Inventory assessed the learning needs of the 2 groups by asking about 48 areas. “I need to know” items ranged from “why I am short of breath” to “what I can do to improve my heart function” to “how significant my heart failure is.” The 8 subscales (topics) were general heart failure information, psychological information, risk factors, medications, diet, activity, prognosis, and signs and symptoms.

Individually, patients placed the most importance on the items “what can happen if I do not follow my doctor’s recommendations,” giving it a mean (SD) score of 4.28 (1.07) and the least on “when I can engage in sexual activity,” with a mean score of 2.32 (1.41). However, most important to health care providers was “what happens when someone has heart failure” (4.45 [0.95]) and least, “the normal emotional response to having a chronic illness” (3.40 [0.94]).

Medication knowledge proved to be a topic of significant importance to both groups, with the patients wanting to know more about the medications and the health care providers wanting to inform their patients to a similar degree on them. Other significant items they differed on, however, included fluid restriction, alcohol consumption, and daily weights—despite the patients deeming them “essential aspects of self-management.”

Adequate communication is at the root of education here, with patients noting difficulties expressing how they truly feel to their health care providers, who they fear will ignore their concerns, and the providers thinking the patients don’t know enough.

“In order to improve [heart failure] self-management, it is undoubtedly necessary for healthcare providers to investigate the level of knowledge of their patients before educating them and providing tailored interventions based on their actual learning needs,” the authors concluded. “Although it is important to provide medical information and knowledge, it is also critical to consider how it will be best applied in the real-world lives of [heart failure] patients.”

Reference

Min D, Park J-S, Choi E-Y, Ahn J-A. Comparison of learning needs priorities between healthcare providers and patients with heart failure PLoS One. Published online September 24, 2020. doi:10.1371/journal.pone.0239656