Illness Perception in Patients with Peripheral Arterial Disease – A Systematic Review

Abstract

Introduction: Patients with chronic diseases such as peripheral arterial disease (PAD), create their own subjective beliefs, of the condition, based on their illness perceptions. In the Common-Sense Model (CSM), illness perceptions is constitute of personal beliefs of the illness, with regard to identity, timeline, cause, control and cure, and consequences. Patient's illness perception affects both their management of the disease and the adherence to treatment. Since patients with PAD is in need of life-long treatment regarding secondary prevention, generating knowledge about the beliefs of their illness is essential. The aim of this study was to review and synthesize illness perception in patients with PAD. Methods: A systematic review of available qualitative studies was performed. A systematic search strategy was conducted in PubMed, CINAHL, and PsycINFO. Studies were included based on the inclusion criteria. References from the included studies were evaluated for additional studies. A quality appraisal of the studies was made, independently, by two of the authors and to avoid conflict of interest, three studies were appraised by two other authors in the team. Data were synthesized using a “best-fit” approach to framework analysis (Carroll et al, 2011). The framework used was the Common-Sense Model (Leventhal et al 1984). Results: Fourteen studies were included conducted between 1997 and 2017 with 316 participants (191 men, 125 women), aged between 44 and 92 years, in North America and Europe. The participants had a various severity of PAD, with preponderance of intermittens claudication (IC). The methods used in the studies were individual interviews (n=10), focus group interviews (n=3) or both (n=1). The quality appraisal resulted in high quality in six studies and medium quality in eight studies. Findings showed that participants had different illness perceptions of the identity of PAD. Participants described that their symptoms were related to PAD, other comorbidities, aging, or had no idea. The timeline beliefs differed between being a chronic condition to something transient. The causal beliefs were presented with a variety of factors dominated by lifestyle factors, and comorbidity. Participant's illness perception concerning treatment, showed beliefs in benefits from walking, but uncertainty of why, and to what extent. High expectations of surgical treatment were discernable. Participants with PAD experienced embarrassment, feelings of inadequacy, worries about the future, and unintentional isolation due to incapability to participate in activities. Finally, the participants showed a process of adapting to a different way of life due to living with PAD, which was a result outside the framework of the CSM. Conclusion: Patients with PAD shape their own understanding of their condition. These diiferent beliefs may influence their management of their disease and the adherence to treatment. Therefore, the current study suggests that illness perceptions are addressed when planning secondary prevention for patients with PAD. Disclosure: Nothing to disclose