The effectiveness of patient-centered self-care education for adults with heart failure on knowledge, self-care behaviors, quality of life, and readmissions: a systematic review

Background Patient-centered self-care education is an educational approach that employs meaningful, targeted education tailored to an individual patient's needs, preferences, and values. Patient-centered educational approaches may empower patients with heart failure to be successful in self-care management and improve outcomes. Objective To evaluate the effectiveness of patient-centered self-care education for adults with heart failure on knowledge, self-care behaviors, quality of life, and readmissions. Inclusion criteria Types of participants Adult patients, 18 years and older, with a diagnosis of heart failure. Types of interventions All types of patient-centered, self-care education interventions for adult patients with heart failure provided by any health care provider. Types of outcomes Heart failure knowledge, heart failure self-care behaviors, heart failure-related quality of life, heart failure admissions or readmissions within one-year post intervention. Types of studies Randomized controlled trials. Search strategy The search strategy aimed to find relevant published and unpublished studies in the English language between January 1990 and July 2013. Several electronic databases were searched: CINAHL, Pubmed, PsychINFO, EMBASE, CENTRAL, ERIC, Scopus, and DynaMed. A search for gray literature was also performed. Methodological quality Two reviewers evaluated the included studies for methodological quality using standardized critical appraisal instruments from the Joanna Briggs Institute. Data collection Data were extracted using a standardized data extraction instrument from the Joanna Briggs Institute. Data synthesis Due to clinical heterogeneity between included studies, statistical meta-analysis was not possible. Results are presented in a narrative form. Results A total of seven articles describing five randomized controlled trials and one pseudo-randomized trial were included. Four studies demonstrated reduced readmissions with only one reaching statistical significance at six months follow-up (11.4% intervention, 44.2% control, P=0.01). Five studies demonstrated an improvement in quality of life with only one reaching statistical significance between baseline and 12 months follow-up (P=0.002). One study measured knowledge and demonstrated a statistically significant improvement at the 12 months follow-up (P=0.05). One study measured self-care and demonstrated a statistical significant improvement among the intervention group at one month (P<0.001) and three months (P=0.005) compared with the control. These statistical significant findings indicate the positive effects of the intervention by demonstrating an improvement in outcomes as measured by patients experiencing a more productive quality of life, an increase in heart failure-related knowledge, improved self-care behaviors, and decreased readmission rates post intervention. Conclusions Patient-centered self-care education for adult patients with heart failure may have a positive benefit in reducing heart failure readmissions and improving heart failure-related knowledge, self-care behaviors, and quality of life. Factors that may influence outcomes include a multidisciplinary team approach and reinforcement of individualized advice with emphasis during care transitions. Implications for practice Utilization of a multidisciplinary team in a variety of settings with ongoing reinforcement of individualized goals and objectives, while continually assessing patient-specific needs, may be necessary in effecting care delivery. Implication for research Future studies may consider interventions inclusive of more diverse ethnic populations of varying literacy and socio-economic levels, promoting generalizability of findings. Greater details specific to the patient-centered aspect of the intervention, including optimal time-frames for duration should be determined.