Family Influences on Heart Failure Self-care and Outcomes

Abstract

Many patient education guidelines for teaching heart failure patients recommend inclusion of the family; however, family-focused interventions to promote self-care in heart failure are few. This article reviews the state of the science regarding family influences on heart failure self-care and outcomes. The literature and current studies suggest that family functioning, family support, problem solving, communication, self-efficacy, and caregiver burden are important areas to target for future research. In addition, heart failure patients without family and those who live alone and are socially isolated are highly vulnerable for poor self-care and should receive focused attention. Specific research questions based on existing science and gaps that need to be filled to support clinical practice are posed.Keywords caregiver outcomes; family functioning; family support; heart failure; patient education; self-care; self-management Efforts to bolster self-care in heart failure (HF) patients are paramount to improving behaviors related to diet and medication adherence, reducing hospitalization, and enhancing overall outcomes. Self-care in HF is quite variable, and new approaches are needed to promote preventable hospitalizations, reduce symptoms, and improve quality of life. Published clinical practice guidelines suggest that both patients with HF and their family members or care-givers should receive individualized education and counseling that emphasizes self-care 1 ; however, the data to guide family education and care in HF are sparse. This review will examine the literature related to HF self-care and family concepts including descriptive research on family variables and behaviors, the relationship of family variables to outcomes, and family intervention studies. Finally, recommendations for HF practice and future research will be presented. Copyright NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptThe concept of family is highly relevant to self-care, and a recent framework published by Grey and colleagues 2 outlines the relationships among family factors, individual, and family selfmanagement of chronic illness. Using a structure, process, and out-comes framework, the model identifies family structural variables as risk and protective factors that influence individual and family self-care and self-management behaviors as part of health promotion or chronic disease care. These behaviors, such as healthy eating or medication-taking activities, then lead to clinical outcomes. Family functioning (which has dimensions of adaptability, problem solving, and communication and roles) in this model also is viewed as an outcome of self-management; however, in other chronic illness populations, family functioning is often understood as a precursor to effective self-care. Regardless of where it is placed in models, when family functioning is not optimal, managing a complex self-care regimen, such as that prescribed for HF patients, will not be as effective as it could be. Better family fun...

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