Understanding The Heart Failure Symptom Perception Process

Solim Lee, University of Pennsylvania


Background: Symptom perception is theoretically defined as a comprehensive process of monitoring, becoming aware of bodily changes, and evaluating the meaning of the changes. Because heart failure (HF) patients struggle more with symptom perception than any other element of self-care, this multifaceted concept was newly added in the Situation Specific Theory of Heart Failure Self-Care. Symptom perception is necessary to respond to symptoms. However, patients with HF often face challenges that interfere with symptom perception. For a better understanding of the novelty of the concept of symptom perception in HF, we addressed these specific aims: (1) describe the research conducted on HF symptom perception to further understanding of this new concept; (2) describe how patients with HF perceive symptoms and what influences the process of symptom perception; (3) explore where patients with HF have difficulties in the symptom perception processes of monitoring, awareness, and evaluation; and (4) describe the characteristics of patients with consistent symptom perception in HF.Methods: A comprehensive integrative review and a convergent mixed-methods study were conducted. The findings from the mixed-methods study were reported in a qualitative descriptive paper and a mixed-methods paper. Results: The integrative review illuminated that existing research fails to capture all of the elements in the theoretical definition of symptom perception. The qualitative descriptive study described that how patients with HF perceive symptoms. Three major themes of Body listening, Trajectory of bodily change, and Exclusionary process emerged from an in-depth description of the complex symptom perception processes of monitoring, awareness, and evaluation. Factors influencing each symptom process were identified. The mixed-methods study revealed that most of the participants demonstrated an adequate level of overall symptom perception, but some participants had difficulties in either symptom monitoring or evaluation. The characteristics of patients with consistent symptom perception were identified. Conclusion: This dissertation study advances current knowledge on the symptom perception process in HF. What we have learned about symptom monitoring and evaluation can be used to develop tailored interventions aimed at improving self-care of adults with HF.