Caregiver Decision-Making and Telemonitoring in Heart Failure

Study One: Decision-Making by Caregivers of Family Members with Heart Failure

The population for this study consisted of family members of individuals with cardiovascular conditions who may develop heart failure or who are currently living with it. The intention was to determine how prepared family members were to handle worst-case scenarios regarding the patient's care.

The sample was comprised of individuals whose family members have heart failure. A strength of this sampling strategy is that only directly affected people are involved. A weakness, however, is that these individuals are already aware of their family member's condition and the likelihood that they will eventually have to manage the realities of caregiving for their loved one.

Sampling Strategy and Vulnerable Subjects in Study One

All subjects involved in this investigation were vulnerable in that they were emotionally invested in the issue. Each participant was not only related to someone with heart failure but was also actively involved in that person's care and in preparing to eventually make final decisions on their loved one's behalf. This places them in an extremely emotional state, which represents a meaningful vulnerability for research participants.

Evident HIPAA concerns in the study center on how researchers were able to identify patients with heart failure and their relatives. It is likely that some degree of privacy was compromised in order for researchers to locate this information.

Signed documentation was required by the researchers for participation in the study, thereby ensuring informed consent.

Ethical Considerations and Research Design in Study One

The setting for the study is difficult to identify clearly. While the questions involved hospital care, they also addressed in-home care of patients with heart failure, meaning the setting can be defined as twofold.

The sample for this research design was adequate because the information gathered in each case was determined by the level of interaction families had with healthcare practitioners. Researchers examined how family members sought information, solicited input from health professionals, and drew on the support of both doctors and nurses as well as others dealing with heart failure. They also studied how these families reflected on their situation, evaluated possibilities, and ultimately decided on the best course of action for their loved ones (Sanford et al., 2011).

One hundred and two patients dealing with heart failure were interviewed for the study, along with one hundred and two caregivers who look after those patients. Eighty-four dyads — that is, pairs of caregiver and patient — actually completed the study.

Study Two: Telemonitoring of Heart Failure Patients and Their Caregivers

The sample was selected from patients with heart failure and then randomly divided into two groups following their discharge from the hospital. This randomized approach is a recognized strength for minimizing selection bias in randomized controlled trials.

There were definite risks for those involved in the study. Patients were being tested to determine whether telemonitoring of symptoms by a nurse could prevent or reduce readmissions, costs, and emergency room visits. Whether overtly stated or merely implied, patients would be encouraged to seek medical attention only through telemonitoring by the practicing nurse, which represents a significant medical risk for those patients.