A randomised control trial of a symptom management package for people with acute coronary syndrome

Research output: ThesisDoctoral Thesis

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Abstract

More people die of cardiovascular disease in Australia than from any other condition. Acute Coronary Syndrome (ACS) is the acute event of the chronic condition coronary heart disease (CHD) represents a continuing spectrum of three conditions and can be divided into unstable angina, non ST elevation myocardial infarction (NSTEMI) and ST elevation myocardial infarction (STEMI). Patients’ symptoms in all three conditions are self managed by the first line medication sublingual glycerine trinitrate (SLGTN). The aim of management of ACS is to minimise symptoms and improve quality of life (QOL). Education of this complex medication such as recommended route, timing, side effects, prophylactic use and response to emergency when symptoms are not relieved are essential for the person to be able to effectively self administer the medication. Nitrates such as SLGTN have different biovariabilities and pharmokinetic properties which can have potent adverse effects such as vasodilatation if not taken correctly. Patients self-manage and prevent angina symptoms using SLGTN and rest when they are home; therefore it is essential that they have adequate knowledge of SLGTN and its use. However previous studies have reported patients have poor knowledge of SLGTN and appropriate symptom management. The current in-hospital education available is suboptimal and contains limited information on symptom management, or is provided during cardiac rehabilitation programs (CRP) often four to six weeks post discharge from hospital. However, very few people attend outpatients’ education programs thus increasing the potential for many patients to not receive symptom management education. Therefore it is vital to provide standardised in-hospital education on symptom management. There are few studies that have provided symptom management education strategies. Those that have suggest that a person’s knowledge of symptom management can be improved by providing specific information about how to self- manage angina. The aim of this study was to develop and evaluate the effectiveness of a specifically developed symptom management education package (SMEP) for people with ACS delivered in-hospital. Based on the Knowles’s Adult Learning theory (KALT) and learning styles, participants randomised to intervention group received a three resource SMEP containing a leaflet, refrigerator magnet and digital video disc (DVD) on symptom management centred on the use of SLGTN. This study used symptom management theory (SMT) to guide the research. A randomised control trial (RCT) with a pre test (T1) and a post test (T2) was used to test the two hypotheses. The study was conducted in a large Australian public metropolitan tertiary hospital. A total of 169 participants completed this study with 84 in intervention group and 85 in control group. Pre test and post test instruments included the Sublingual Nitro-glycerine Interview Schedule (SNIS) and the Seattle Angina Questionnaire (SAQ). Hypothesis 1 was; people with ACS who received a SMEP and usual care will have improved knowledge and knowledge of SLGTN use when measured using SNIS compared to people who received usual care. Hypothesis 2 was; people with ACS who received a SMEP and usual care will have improved QOL when measured using SAQ compared to people who received usual care. Data were collected in-hospital and four to six weeks post discharge. Knowledge of the medication SLGTN was significantly increased in both groups when tested four to six weeks post discharge. Importantly, when using a mixed between-within analysis of variance (ANOVA), the intervention group improved significantly more than the control group (p<0.001) thus supporting this component of hypothesis 1. Similarly, both groups significantly improved their knowledge of SLGTN use, however, no significant differences were detected between the two groups. Similarly, both groups significantly improved their knowledge of SLGTN use, however, no significant differences were detected between the two groups. The second hypothesis examined the effect of the SMEP on QOL using the SAQ compared with people with ACS who receive usual care only. There were statistical significant increases in angina frequency for both groups and physical limitations (measure of physical functioning) for the intervention group and angina stability for the control group from in-hospital to four to six weeks after discharge. There were no statistically significant differences between pre test and post test for physical limitation, angina frequency and stability, treatment satisfaction, disease perception/heart focused anxiety thus the second hypothesis was not supported. To date, limited research has been located that have investigated strategies aimed at improving knowledge of SLGTN, knowledge of SLGTN use and QOL, this is one of the few studies to examine participants’ knowledge of SLGTN and knowledge of SLGTN use following a brief concise in-hospital symptom management education package. This RCT to enhance patient education was the first study that used the SMT to provide information participants needed. This study also considered different learning styles and levels of literacy. A brief concise structured inexpensive SMEP shows promise in improving symptom management knowledge of people with ACS. Recommendations are that the SMEP be implemented into clinical practice in the in-hospital setting to ensure patients receive timely education on symptom management. Future research is needed in longer term studies and in English-as-second-language populations to further examine the efficacy of the SMEP.
Original languageEnglish
QualificationDoctor of Philosophy
Awarding Institution
  • Griffith University
Supervisors/Advisors
  • Mitchell, Marion, Principal Supervisor, External person
  • Lin, Frances, Co-Supervisor, External person
Award date27 Jul 2016
Place of PublicationAustralia
Publisher
Publication statusPublished - 11 Aug 2015

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