Abstract 140: Predictors of Patient Self-Advocacy (PSA) in Heart Failure (HF)

Abstract

Objective: Patients with heart failure self-manage by communicating with various providers. Knowing what impacts patient communication must inform how providers relate to these chronically ill patients. Patients are becoming more assertive. Providers and organizations are asking them to be more assertive. The American Heart Association literature, “Heart-to-heart: Talking to Your Doctor [Healthcare Provider]” (AHA, n.d.) stresses direct communication.and asking questions which is a form of self-advocacy (AHA, n.d.). Self-advocating, or speaking-up, involves gaining and using knowledge to assertively communicate and make decisions (Brashers, 1999). Investigating what influences PSA in patients with heart failure, who access providers and the system frequently, can help us better understand this evolving behavior. Without PSA interventions cannot be individualized or targeted in ways that patients feel are important and are therefore willing to adhere to. The purpose of this study was to examine the direct and indirect effects of PSA and its predictors of trust in nurses and social support on psychological distress and physical symptoms in patients with chronic heart failure. Seven hypotheses were tested relating to the indirect and direct relationships between variables. Design: A cross-sectional, path analysis design was used to test two models. The distal outcomes of psychological distress and physical symptoms were separated into two models. IRB approval was obtained. Surveys were collected from a convenience sample of 80 HF clinic out-patients. (This is the quantitative strand of a mixed methods study. The qualitative strand analysis will be complete at time of conference). Population Studied: Eighty adults from one out-patient clinic with a diagnosis of HF for 3+ months who have had at least two visits at the out-patient care clinic participated. Findings: Neither of the two models tested fit the study data as hypothesized. A respecified model was tested and fit the data well (chi square 9.452, df 6, p .105, RMSEA .085). Trust in nurses directly influenced PSA knowledge. Social support directly influenced PSA assertiveness. And social support directly influenced depressive symptoms. Conclusions: Nurses have a direct relational role in helping patients use knowledge to speak-up. Nurses have a role in helping patients access and take advantage of social support so that patient assertiveness can be enhanced. Implications: Trusting providers and social support is important to patient self-advocacy. Interventions designed to increase trust in provider, increase social support and social skills may have a positive impact on a patient’s level of self-advocacy. The outcomes of PSA in patients with heart failure need to be studied further.The outcomes of PSA in patients with heart failure need to be studied further.