"Patient-Reported Outcome Measures" Enhance the Nursing Process and Patient-Centered Care in Heart Failure

Purpose: Despite costly advances in heart failure management, heart failure is characterized by pervasive adverse and complex symptoms, functional decline, and poor quality of life. The purpose of this study is to incorporate Patient Reported Outcome Measure (PROM)data into the nursing process, augmenting usual nursing assessments with robust patient specific reports. This study aims to detect unmet care needs identified by integrating patient reported data in the nursing assessment, via PROMs measuring multidimensional symptoms, and health related quality of life, and testing their associations with other nursing assessment factors.

Methods: This cross sectional, correlational study used data collected from 88 individuals undergoing inpatient heart failure treatment in a large urban academic medical center (50% male, average age 67±6. 9, median duration of heart failure >4 years, mean vEF =32%). Following consent, patients completed a 30 minute interview consisting of valid, reliable ‘patient reported outcome measures’ of symptom burden, and health related quality of life. PROM data augmented nursing assessments and disease, treatment, and social characteristics abstracted from medical records. Data analyses of assessment and PROM findings were conducted using correlation, non parametric statistics and regression models.

Results: ‘Patient reported outcome measures’ had good internal reliability (Cronbach’s alpha >.8). The most prevalent symptoms reported (75-97%), were xerostomia, dyspnea, fatigue, pain, worry and sleep disruption. Statistically significant differences were detected in symptom burden associated with gender; symptom frequency, severity and or associated distress was increased in women participants compared with men (r=-.21, p=.048). Increased symptom burden associations with decreased functional status were statistically significant, beginning at the 40% threshold on the Karnofsky Performance Scale (r=.40, p=.001) assessed in the participants.

Conclusion: ‘Patient reported outcome measures’ contribute unique findings to inform the nursing process and patient centered heart failure treatment. Care quality opportunities identified in this sample include multidimensional symptom management, functional support, disease and treatment education, and advance care planning; all components of primary palliative care.