运用常态过程理论理解慢性心力衰竭患者的治疗负担体验。
Understanding patients' experiences of treatment burden in chronic heart failure using normalization process theory.
机构信息
Academic Unit of General Practice and Primary Care, Centre for Population and Health Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland.
出版信息
Ann Fam Med. 2011 May-Jun;9(3):235-43. doi: 10.1370/afm.1249.
PURPOSE
Our goal was to assess the burden associated with treatment among patients living with chronic heart failure and to determine whether Normalization Process Theory (NPT) is a useful framework to help describe the components of treatment burden in these patients.
METHODS
We performed a secondary analysis of qualitative interview data, using framework analysis, informed by NPT, to determine the components of patient "work." Participants were 47 patients with chronic heart failure managed in primary care in the United Kingdom who had participated in an earlier qualitative study about living with this condition. We identified and examined data that fell outside of the coding frame to determine if important concepts or ideas were being missed by using the chosen theoretical framework.
RESULTS
We were able to identify and describe components of treatment burden as distinct from illness burden using the framework. Treatment burden in chronic heart failure includes the work of developing an understanding of treatments, interacting with others to organize care, attending appointments, taking medications, enacting lifestyle measures, and appraising treatments. Factors that patients reported as increasing treatment burden included too many medications and appointments, barriers to accessing services, fragmented and poorly organized care, lack of continuity, and inadequate communication between health professionals. Patient "work" that fell outside of the coding frame was exclusively emotional or spiritual in nature.
CONCLUSIONS
We identified core components of treatment burden as reported by patients with chronic heart failure. The findings suggest that NPT is a theoretical framework that facilitates understanding of experiences of health care work at the individual, as well as the organizational, level. Although further exploration and patient endorsement are necessary, our findings lay the foundation for a new target for treatment and quality improvement efforts toward patient-centered care.
目的
我们的目标是评估慢性心力衰竭患者治疗相关的负担，并确定规范化进程理论（NPT）是否是一个有用的框架，以帮助描述这些患者治疗负担的组成部分。
方法
我们使用框架分析对定性访谈数据进行二次分析，该分析受 NPT 指导，以确定患者“工作”的组成部分。参与者是 47 名在英国初级保健机构接受慢性心力衰竭管理的患者，他们曾参与过一项关于患有这种疾病的早期定性研究。我们确定并检查了超出编码框架的数据，以确定是否有重要的概念或想法被选择的理论框架所遗漏。
结果
我们能够使用该框架识别和描述治疗负担与疾病负担的不同组成部分。慢性心力衰竭的治疗负担包括对治疗方法的理解、与他人合作组织护理、就诊、服用药物、采取生活方式措施以及评估治疗方法等方面的工作。患者报告增加治疗负担的因素包括药物和就诊次数过多、获取服务的障碍、护理分散且组织不良、连续性不足以及医护人员之间沟通不足。超出编码框架的患者“工作”完全是情感或精神性质的。
结论
我们确定了慢性心力衰竭患者报告的治疗负担的核心组成部分。研究结果表明，NPT 是一个理论框架，有助于理解个人以及组织层面的医疗保健工作的体验。尽管还需要进一步探索和患者认可，但我们的发现为以患者为中心的护理的治疗和质量改进工作的新目标奠定了基础。
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