2405Comparison of patient reported versus clinician estimated self-care in heart failure: results from the MENSCH-NZ study

Abstract

Background: In heart failure care, patients and clinicians work in partnership to improve outcomes and self-care. To improve future patient-centred care, we need to investigate whether there is agreement between self-care as reported by the patient and as estimated by the clinician. Purpose(s): The purpose of this analysis was to investigate congruency in patient reported self-care and clinician estimated self-care, both an overall score as well as individual items. As a secondary aim we explored whether there are differences with regard to ethnicity, i.e. Maori vs non-Maori. Method(s): In the observational cross-sectional "Empathy, self-rated health and self-care in heart failure (MENSCH-NZ)" study, we consecutively enrolled patients referred to two rural nurse-led heart failure services, at their discharge appointment, between May 2016 and July 2017. Self-care was assessed using the 9-item European Heart Failure Self-care Behaviour Scale (EHFScBS). The scale was adapted for clinicians to also estimate patients' self-care skill (EHFScBS-C). The item content is identical but the clinician version has been adapted linguistically, eg. item 1 "I weigh myself every day" was adapted to "The patient weighs themselves every day". The overall scale score range is from 0-100, with higher scores indicating better self-care. Patient clinical and sociodemographic data were documented as part of the routine clinic appointment. Result(s): Of all (n=120) patients, 40% were female, mean age 71 (SD11), 80% Caucasian, 20% Maori/Pacific Island ethnicity, 93% NYHA class I-II. EHFScBS mean score was 67 (SD18) versus EHFScBS-C mean score of 62 (SD15) (mean (95% CI) difference 5.2 (1.4, 9.0) P=0.0078; Spearman r=0.43). There was no difference in EHFScBS with regard to ethnicity (Maori mean score 65 vs. non-Maori 68; P=0.57). However, clinician estimated (EHFScBS-C) mean score was lower for Maori than for non-Maori (54 vs. 64 respectively; p=0.007). Of the individual 9 items there was significant agreement (kappa coefficient P all <0.03) between patient and clinician in: Weighing daily, contacting Dr/nurse with breathlessness, contacting Dr/nurse with swelling ankles, limiting the amount of fluid intake, con-tacting Dr/nurse with fatigue and exercising regularly. The remaining three items: contacting Dr/nurse with 2kg weight gain, eating a low salt diet and taking medications regularly were not significantly congruent (all P>0.09). Conclusion(s): Generally, clinicians estimated the self-care behaviour lower than what patients reported. This indicates a need for increasing emphasis of clinicians communicating their assessment with the patient so as to identify incongruencies. No difference between overall self-care scores of Maori vs. non-Maori was evident. However, clinicians estimated the self-care of Maori lower than of non-Maori patients, which may indicate an assessment bias. This finding warrants the need for further research with larger samples.