Systematic Review of Nurse-Led Experimental Studies of Self-Management Interventions for Chronic Illness

Dickson, Victoria Vaughan

Friday, July 15, 2011: 4:25 PM

Victoria Vaughan Dickson, PhD, RN, CRNP¹
Marilyn Hammer, PhD, DC, RN¹
Kelley Newlin, ANP¹
Elizabeth Ercolano, RN²
Jill Nocella, MSN, RN¹
Deborah Chyun, PhD, RN¹
Gail D'Eramo Melkus, EdD, C-NP, FAAN¹
(1)College of Nursing, New York University, New York, NY
(2)School of Nursing, Yale University, New Haven, CT

Learning Objective 1: Describe the evidence for common definitions and methods among nurse-directed self-management interventions for chronic illnesses; .

Learning Objective 2: Discuss the evidence for intervention effectiveness based on unique program attributes.

Purpose: Interventions facilitating chronic illness knowledge and skill behaviors for patients [often who have more than one common condition – diabetes, cardiovascular disease (CVD), cancer)] are referred to as self-management, self-care, or symptom management interventions, respectively. The extent to which interventions, developed and tested by nurse scientists share common operational definitions and methods is not well known. This integrative review sought to: 1) determine the extent of nurse-directed “self-management” intervention studies; 2) analyze evidence for common definitions and intervention methods; and 3) determine evidence for effectiveness of interventions based on unique program attributes.

Methods: A systematic integrative review based on PRISMA guidelines examined the conceptual basis, operational definition, methods, and outcomes of “self-management” in nurse-directed experimental and quasi-experimental studies in the diabetes, CVD, and oncology literature, years 2000-2010. Data from 139 studies meeting specific inclusion criteria were coded based on: (1) population; (2) conceptual framework; (3) design; (4) intervention components; (5) measures; and (6) outcomes with a categorization scheme generated. Data analysis included identification of categorical patterns across studies

Results: A variety of interventions have been tested in these populations; bundled interventions were most common (40%). Only 20% of the intervention studies targeted ethnic minorities and few were guided by conceptual frameworks. Outcomes and effectiveness varied widely. Diabetes self-management interventions examined physiological measures (i.e., HbA1C) with significantly improved outcomes. CVD self-care interventions measured effect on quality of life with mixed results that lacked sustainability over time. Effective cancer interventions focused on symptom management through the use of exercise for treatment-related fatigue.

Conclusion: Currently, there is insufficient evidence to support adoption of generic chronic illness self-management guidelines. Research is needed to better understand the effect of specific intervention components of bundled interventions on outcomes with guiding conceptual frameworks. Development and testing of culturally relevant self-management interventions is critically needed.

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