Review of caregiver decision-making and telemonitoring heart failure studies

Sanford, J., Townsend-Rocchicciolli, J., Horigan, A., & Hall, P. (2011). A process of decision making by caregivers of family members with heart failure. Research & Theory for Nursing Practice, 25(1), 55-70.

Describe the data collection procedure.

This was a QUALITATIVE grounded theory study. Unstructured open-ended interviews were conducted in private mutually agreed on locations. Interviewers took notes and interviews were audiotaped. Interviews lasted from 45 minutes to 2 hours

what did the authors say about the reliability and validity of their data collection and analysis?

The authors did not address this point. On the contrary, they point out how their study contributes to previous studies on the topic.

What demographic information was reported?

The caregiver had to be related to the patient with heart failure, provide one activity of daily living, and/or assist the care recipient with two instrumental activities of daily living and not be paid for services. Demographic data collected included caregiver gender, marital status, ethnicity, employment status, income, living arrangement, and relationship to patient with HF

4) what were the variables that were studied?

Questions specifically related to decision making were asked.

5) How were the data analyzed after collection? Was there any special software used?

Data was transcribed verbatim, checked for accuracy, and entered into the NVivo qualitative software program. Researchers independently coded the data line by line after each interview and then met for focused coding to develop the most salient categories of the data. The core conceptual categories were identified, and links between them resulted in theoretical categories. A theoretical model was developed that describes the process of decision making by caregivers of family members with HF

6) Discuss the use of any figures, graphs and tables. Was the information conveyed in an understandable and meaningful way?

The two Tables (on decision-making questions and demographics) were clear and instantly comprehensible. The Figure was clear to. Both were referred to and elaborated on in text.

7) Discuss the authors' conclusions. Do you feel these conclusions are based on the data that they collected?

The authors concluded that decision-making of caregivers was a nonlinear process consisting of various characteristics.

The collected data, as well as previous studies seems to support their conclusions but their population sample was small, only 20 individuals and cannot be used to extend to a larger population.

The following questions pertain to: Schwarz, K., Mion, P., Hudock, D., & Litman, G. (2008). Telemonitoring of heart failure patients and their caregivers: A pilot randomized controlled study. Progress in Cardiovascular Nursing, 23(1), 18-26.

8) Describe the data collection procedure.

Participants were interviewed soon after discharge and 3 months later about effects of telemonitoring on depressive symptoms, quality of life, and caregiver mastery.

9) How did the authors address the reliability and validity of the instruments used?

The authors discussed each instrument used including indications of its reliability and validity

10) what limitations did the authors face in data collection? How could these have been lessened or minimized?

There were various limitations:

1. The study used a category of patients who were more severely ill. A replication study using less severely ill patients may lead to greater differences between groups

2. The teaching before the hospital discharge could also have been more consistent between the two groups

3. A formalized monitoring system could be used to ensure that patients take medications as required

4. Information about dosages or changes in medications was not collected, and these variables could have differed between groups and affected results.

4. Specific number of visits to the patients' cardiologist/primary physician and how physicians responded to nursing assessments were also not obtained as part of the study.

5. There was lack of attention to paperwork that may have impacted study results.

12) What were the variables that were studied?

Variables: whether telemonitoring by an advanced practice nurse reduced subsequent hospital readmissions, emergency department visits, costs, and risk of hospital readmission for patients with Heart failure.

13) Were there any inferential tests used in the analysis of data in this study? If so, what were they?

Functional status was measured as the ability to perform ADLs and IADLs at baseline and 90 days' postdischarge.

Depressive symptomatology was measured using the Center for Epidemiological Studies Depression Scale (CES-D)

Quality of life, defined as patient's perceptions of the effects of HF on one's life, was measured with 18 items from the Minnesota Living with HF questionnaire (MLWHF)

Caregiver mastery was measured with the mastery subscale from the Philadelphia Geriatric Center Caregiving Appraisal Scale (PGCCAS)

Informal social support was measured with the tangible subscale from the Modified Inventory of Socially Supportive Behaviors Scale (MISSB)

14) Discuss the use of any figures, graphs and tables. Was the information conveyed in an understandable and meaningful way?

Tables and figures were more thorough than clear. They seemed to be for a professional rather than lay readership.