The document discusses the important roles of healthcare professionals in optimizing patient outcomes. It outlines several key roles including support, education, coping skills training, symptom management, addressing family needs, and facilitating transition and recovery. Effective communication between healthcare providers and patients is essential. The summary also highlights predictors of improved outcomes such as social support, self-efficacy, and shared decision-making.

1. Optimizing Patient Outcomes:
Role of the Healthcare Professional
Eva R. Serber, Ph.D.
Centers for Behavioral & Preventive Medicine,
The Miriam Hospital
Department of Psychiatry & Human Behavior,
Warren Alpert Brown Medical School

2. Disclosures
• Medtronic, Inc – Speaker Honoraria
• NIH/NHLBI – R21 HL092340 (CARE-E Trial)
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© 2010 Serber

3. The healthcare professional has
many roles:
• Support
• Education
• Coping skills training
• Symptom management
• Transition and recovery
• Addressing family needs
…to name a few
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© 2010 Serber

4. Communication
Support
Patient Outcomes
Education
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© 2010 Serber

5. Predictors of Improved Outcomes
• Understanding of disease and treatment
• Social support
• Self-efficacy
• Self-management
• Positive outlook and expectations
• Shared decision-making
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© 2010 Serber

6. Social Support
• Encouragement
• Facilitating activities
• Seeking meaningful information
• Sharing experiences, concerns, feelings
• Forming relationships
– With peers
– Health care providers
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© 2010 Serber

7. Common SCA/ICD Patient
Concerns
• Preventive care
• Health care providers
• Partner relationships
• Activities of daily living
• Physical changes
• Emotional challenges
• Coping with shocks
Dougherty et al., Adv Nurs Pract 2001
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© 2010 Serber

8. Effective Education
• Find out what works
• Find out what is needed
• Let the patient play
• Encourage planning and prep
• Be patient
• Model problem-solving
Boyd et al., 1997; Lorig, 2001; Overgaard, Nurs Crit Care 2010
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© 2010 Serber

9. Patient’s Preferences
• Support – psychosocial or adjustment needs
– Office visit or call with device nurse (23-25%)
– Support group (15%)
• Education – content of dx, ICD, coping strategies
– Written materials (48%)
– Office visit with cardiologist or nurse (42%, 40%)
• Interest in attending Supportive and Educational
ICD meeting (68%)
Serber et al., PACE 2009
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© 2010 Serber

10. Disparities in Preferences
• African-Americans – written materials and phone
contact with cardiologist
• Women – Support from ICD peers, device nurse,
professional counselor
• Young Age (< 67 yo) – Internet and e-
communication for support and education
Serber et al., PACE 2009 Ψ
© 2010 Serber

11. Benefits of Communication
Without intervention:
• No change in uncertainty and adjustment 1- to 8-
wks post ICD
With intervention:
• Psychoeducation: ↓ s/o depression, anxiety, ↓
healthcare utilization and sick days
• Recall counseling: ↓ worry and uncertainty
Dunbar et al., PACE 2009 Fisher et al., PACE 2009 Mauro, Int J Nurs Stud 2010
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© 2010 Serber

12. Intervention Outcomes
• Blood pressure • Weight loss
• Lipids • Healthcare utilization
• Physical activity • Mortality
• Smoking • Quality of life
• Dietary intake • Psychosocial outcomes
Allen & Dennison, JCN 2010; Stolic et al., Euro J Cardiovasc Nurs, 2010 Ψ
© 2010 Serber

13. Support Groups
Benefits:
• ↑ coping
• ↑ adjustment to device
• ↑ life satisfaction
• ↑ connection to others
• ↑ health
Dickerson et al., Heart Lung 2000, Clin Nurse Spec 2006
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© 2010 Serber

14. Support Groups
Nurse facilitator:
• Fosters individual participation
• Encourages group cohesion
• Provides medical and technical expertise
• Maintains topic relevance
• Addresses distress and provides referrals
Dickerson et al., Heart Lung 2000, Clin Nurse Spec 2006
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© 2010 Serber

15. Therapeutic Connection & Themes
• Information and education
• Interaction and stories
• Benefiting each other
• Support and friendship
• Importance of a facilitator
• Accessibility (for online)
Dickerson et al., Heart Lung 2000a & b; Serber et al., Heart Lung 2010
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© 2010 Serber

16. “Informed Consent”
• Process – ongoing conversation
• Communication and comprehension
– Description, explanation, trajectory
– Risks or discomforts
– Benefits
– Appropriate alternatives
• Current status and future options
Always comes down to communication –
providing support and education
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© 2010 Serber

17. The 5 A’s
1. Ask: about concerns and wellbeing
2. Advise: provide education about psychosocial
impact
3. Assess: emotional and behavioral sx
4. Assist: be practical; educate; support
5. Arrange: follow-up and refer as needed
Take the time and listen to the person who is your
patient.
Interact with the patient and family in dialog
Fiore et al., 2000; Sotile & Sears, You Can Make a Difference, 1999 Ψ
© 2010 Serber

18. Screening for Psychological
Distress
Ask questions that help identify:
• Emotional factors
• Chronic Stressors
• Somatic complaints
Rozanski et al., J Am Coll Cardiol 2005;45:637-651
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© 2010 Serber

19. Screening for Psychological
Distress
Possible screening questions:
• How has your mood been recently?
• How would you describe your energy level?
• How have you been sleeping?
• What kind of pressure have you been under at
work/home?
• How do you unwind at the end of the day?
Rozanski et al., J Am Coll Cardiol 2005;45:637-651
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© 2010 Serber

20. Specific Areas For Intervention
• Relaxation and shock-anxiety management
– Breathing exercises
– Imagery
– Positive self-talk
• Education
– Cardiac dx, course, and tx
– Relationship between emotions, behaviors, and cardiac
events
• Family involvement
– Pt-focused
– Caregiver strain
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© 2010 Serber

21. Specific Areas For Intervention
• Activity planning and pacing
• Physical activity
• Thought management
– ↓ Negative
– ↑ Positive
• Goal Setting and problem-solving
– Long- and short-term
– Are they realistic?
• Finding meaning and purpose
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© 2010 Serber

22. Know When to Refer & Get
Consult
• Most common times:
– After SCA
– Time of ICD implantation
– Status Post ICD shock
• Other times:
– Pt benefit from more 1-on-1 time than can be provided
during clinic visits
– Treatment adherence issues
– Increase in medical care utilization
– Change in patient temperament, interactions, or loved
ones voicing concerns
– Recognizing own limitations with
psychosocial issues
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© 2010 Serber

23. Thank you!
Questions?
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© 2010 Serber

24. Validated Screening Surveys
• Patient Health Questionnaire
– 2-item, 9-item, or 4 pg comprehensive versions
• Hospital Anxiety and Depression Scale
• Beck Depression Inventory
• Center for Epidemiological Survey Depression
Scale
• Florida Patient Acceptance Scale
• Florida Shock Anxiety Scale
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© 2010 Serber