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Development of a Decision Support Intervention to Improve Symptom Reporting in Persons with Chronic Heart Failure

Wakefield BJ, Dellsperger K, Mehr D, Wakefield D, Boren S. Development of a Decision Support Intervention to Improve Symptom Reporting in Persons with Chronic Heart Failure. Poster session presented at: Midwest Nursing Research Society Annual Conference; 2013 Mar 8; Chicago, IL.


Purpose Chronic heart failure (HF) is a leading cause of disability and death in the United States with over 1 million hospitalizations costing about $39 billion annually. This study developed a patient decision-support tool to improve patient reporting of changes in key symptoms and clinical signs of heart failure to providers. The tool is based on the SBAR format used by clinicians: Situation, Background, Assessment, and Recommendation. Methods Data were collected in three rounds of data collection. A survey containing 30 signs and symptoms of heart failure was distributed to providers in one academic medical setting. Respondents were asked to select the number which most closely represented their experience with the frequency with which each sign or symptom occurred using a 1 to 5 scale (never to almost always). Using the summarized survey responses, providers were invited to attend a focus group meeting to discuss the responses. The group came to consensus on a prioritized list of symptoms and described each using patient-centered terms. This list was distributed to the participants who responded to the Round 1 survey; participants were asked to review and comment on the final document. Results In Round 1, 15 providers responded to the survey (2 Cardiologists, 7 Family Medicine, and 6 General Internists). Frequency ratings ranged from 2.2 to 4.5 on a 5 point scale. In Round 2, 20 of the 30 symptoms were identified as very or somewhat important. Patient-centered terms were developed for each symptom, and the 20 symptoms were grouped into 5 bundles of like symptoms. In Round 3, 9 providers commented on the final document. Results of the initial survey and focus group will be presented, along with the final SBAR tool. Conclusions Work is continuing on developing the final format for the tool; developing a training manual for the tool; identifying strategies that encourage patients to report symptoms; and assisting patients to recognize symptoms. The patient SBAR tool needs to be tested in a population of patients with heart failure.

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