University of Alberta, Edmonton, AB, Canada T6G2G3.
Int J Nurs Stud. 2012 Dec;49(12):1582-97. doi: 10.1016/j.ijnurstu.2012.05.010. Epub 2012 Jun 19.
To understand the process of help-seeking among heart failure patients from the perspectives of patients, caregivers and health professionals.
Systematic review using qualitative meta-synthesis.
A systematic search (20th May 2011) was conducted to identify studies published in English as full papers ≥1995 reporting primary qualitative data with extractable heart failure-specific data or themes related to help-seeking in patients, caregivers or health professionals. Databases searched were: CINAHL, Medline, PsycInfo, Social Science Citation Index, Embase, Social policy/Practice, SocIndex, Ageline, Health Source Nursing, Scopus; additionally, we consulted with experts and manually searched references.
58 studies (990 patients; 274 female, 527 male, 189 sex not described; 229 caregivers, 79 health professionals) were included. Heart failure help-seeking was embedded in daily experiences of heart failure but ongoing symptoms were confusing, ambiguous and disruptive; little support was available from professionals to interpret the presence and significance of fluctuations in symptoms for help-seeking. Other significant barriers to help-seeking were: avoidance-based coping, fear of hospitals and misplaced reluctance to be burdensome. Help-seeking was facilitated by good involvement and frank communication between patients, caregivers and health professionals and the presence of a sense of elevated personal risk.
Health services should harness primary care providers and support patients and caregivers to prioritize development of objective symptom monitoring skills, recognize and personally assimilate the elevated risks of heart failure and help-seeking delays and discourage avoidance-based coping and unwarranted concerns that downplay the significance of heart failure and urgency to address symptoms.
从患者、照护者和卫生专业人员的角度了解心力衰竭患者寻求帮助的过程。
系统综述采用定性元综合分析。
系统检索（2011 年 5 月 20 日），以确定 1995 年以后发表的全文为英文的研究，报告了与心力衰竭患者、照护者或卫生专业人员的寻求帮助相关的原发性定性数据或主题。检索的数据库包括：CINAHL、Medline、PsycInfo、社会科学引文索引、Embase、社会政策/实践、SocIndex、Ageline、Health Source Nursing、Scopus；此外，我们还咨询了专家并手动检索了参考文献。
共纳入 58 项研究（990 例患者；274 例女性，527 例男性，189 例未描述性别；229 例照护者，79 例卫生专业人员）。心力衰竭的寻求帮助是嵌入在心力衰竭的日常经历中的，但持续的症状是令人困惑、模糊和具有破坏性的；专业人员很少提供支持来解释症状波动的存在和意义，以帮助寻求帮助。寻求帮助的其他重要障碍包括：基于回避的应对方式、对医院的恐惧和对成为负担的不当不愿。患者、照护者和卫生专业人员之间的良好参与和坦诚沟通，以及对个人风险升高的感知，有助于促进寻求帮助。
卫生服务机构应利用初级保健提供者，并支持患者和照护者优先发展客观的症状监测技能，认识并个人吸收心力衰竭和寻求帮助延迟的风险升高，并鼓励避免基于回避的应对方式和不必要的担忧，这些担忧会淡化心力衰竭的意义和解决症状的紧迫性。
