Knowledge and communication difficulties for patients with chronic heart failure: qualitative study.

Abstract

Objectives To explore patients' understanding of chronic heart failure; to investigate their need for information and issues concerning communication.

Design Qualitative analysis of in-depth interviews by a constant comparative approach.

Participants 27 patients identified by cardiology and care of the elderly physicians as having symptomatic heart failure (New York Heart Association functional class of II, III, or IV) and who had been admitted to hospital with heart failure in the past 20 months.

Results Participants were aged 38-94 (mean 69 years); 20 had a New York Heart Association classification of III or IV. All had at least one concurrent illness. Participants sought information from the research interviewer about their heart failure, their prognosis, and likely manner of death. They also described several factors that could inhibit successful communication with their doctors. These included difficulties in getting to hospital appointments, confusion, short term memory loss, and the belief that doctors did not want to provide patients with too much knowledge.

Conclusions Good communication requires the ability both to listen and to impart relevant information. Effective and better ways of communicating with patients with chronic heart failure need to be tested. Disease specific barriers to effective communication, such as short term memory loss, confusion, and fatigue should be addressed. Strategies to help patients ask questions, including those related to prognosis, should be developed.

Introduction

Heart failure is a common chronic disease that leads to disability and death. It is the only major cardiovascular disease that has increasing incidence and prevalence.[1 2] Treatments for heart failure slow, but do not stop, the progression of the disease. The successful management of chronic heart failure may require changes in patients' diet, alcohol intake, and smoking behaviour and use of complex drug regimens to prevent episodes of acute decompensation.[3] The limited available evidence suggests that, in some respects, quality of life is poor and often worse than that experienced by patients with other chronic conditions.[4]

Studies in the United States have shown that patients with chronic heart failure find it difficult to retain information and that patients may not appreciate the relevance of information provided by clinicians.[5] Carers of people who have died from heart disease have reported that, although many patients believed that they were dying, few had been told this or discussed it with their doctors.[6]

In this paper we report findings from a qualitative, interview based study that investigated the experience of patients with heart failure. We focus particularly on their experience of communicating with …