Experiences of long-term life-limiting conditions among patients and carers: what can we learn from a meta-review of systematic reviews of qualitative studies of chronic heart failure, chronic obstructive pulmonary disease and chronic kidney disease?

May, C. R. et al. (2016) Experiences of long-term life-limiting conditions among patients and carers: what can we learn from a meta-review of systematic reviews of qualitative studies of chronic heart failure, chronic obstructive pulmonary disease and chronic kidney disease? BMJ Open, 6(10), e011694. (doi: 10.1136/bmjopen-2016-011694) (PMID:27707824) (PMCID:PMC5073552)

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Abstract

Objectives: To summarise and synthesise published qualitative studies to characterise factors that shape patient and caregiver experiences of chronic heart failure (CHF), chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD). Design: Meta-review of qualitative systematic reviews and metasyntheses. Papers analysed using content analysis. Data sources: CINAHL, EMBASE, MEDLINE, PsychINFO, Scopus and Web of Science were searched from January 2000 to April 2015. Eligibility criteria for selecting studies: Systematic reviews and qualitative metasyntheses where the participants were patients, caregivers and which described experiences of care for CHF, COPD and CKD in primary and secondary care who were aged ≥18 years. Results: Searches identified 5420 articles, 53 of which met inclusion criteria. Reviews showed that patients' and caregivers' help seeking and decision-making were shaped by their degree of structural advantage (socioeconomic status, spatial location, health service quality); their degree of interactional advantage (cognitive advantage, affective state and interaction quality) and their degree of structural resilience (adaptation to adversity, competence in managing care and caregiver response to demands). Conclusions: To the best of our knowledge, this is the first synthesis of qualitative systematic reviews in the field. An important outcome of this overview is an emphasis on what patients and caregivers value and on attributes of healthcare systems, relationships and practices that affect the distressing effects and consequences of pathophysiological deterioration in CHF, COPD and CKD. Interventions that seek to empower individual patients may have limited effectiveness for those who are most affected by the combined weight of structural, relational and practical disadvantage identified in this overview. We identify potential targets for interventions that could address these disadvantages.

Item Type:Articles
Additional Information:This work was supported by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Wessex which is a partnership between Wessex NHS organisations and partners and the University of Southampton. Funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscriptb.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Mair, Professor Frances
Authors: May, C. R., Cummings, A., Myall, M., Harvey, J., Pope, C., Griffiths, P., Roderick, P., Arber, M., Boehmer, K., Mair, F. S., and Richardson, A.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > General Practice and Primary Care
Journal Name:BMJ Open
Publisher:BMJ Publishing Group
ISSN:2044-6055
ISSN (Online):2044-6055
Published Online:05 October 2016
Copyright Holders:Copyright © 2016 The Authors
First Published:First published in BMJ Open 6(10):e011694
Publisher Policy:Reproduced under a Creative Commons License

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