Background: People with established coronary heart disease (CHD) and a history of acute myocardial infarction (AMI) have a high risk for further cardiac events. Effective communication about patients’ individual risk is a prerequisite for successful secondary prevention and CHD self-management. In this review we examine how patients experience the delivery of information and communication about CHD risk.
Purpose: To synthesize findings of qualitative studies about patients’ individual experiences of risk communication on secondary prevention after myocardial infarction.
Methods: The qualitative synthesis was conducted using a meta-ethnography (Noblit and Hare); an approach widely used to provide robust evidence on patient beliefs and experiences. A pre-planned search was piloted and implemented across 5 databases (the Cochrane Library; MEDLINE via PubMed; PsycINFO; CINAHL; SSCI) between January 1996 and October 2016. Inclusion criteria were; studies with qualitative or mixed methods design, recruiting participants with established CHD and a history of AMI, reporting findings with at least one category/theme about risk communication. Studies were independently assessed for inclusion by two researchers and a quality appraisal conducted.
Results: Of 2148 initial hits, 41 full-text papers were included, describing the experiences of over 850 participants. Six characteristics of risk information were valued by participants; consistency, individualisation, appropriate levels of detail, timing, location and modality (ie. how information was presented e.g. verbal, written, or pictorial format). Participants’ experiences of using the risk information were characterised by two overarching themes. Converting to context highlighted the complex ways in which participants applied their knowledge of risk within their everyday lives – often adapting self-management recommendations to pre-existing preferences and habits. Dialogue with the self, on the other hand, showed how participants continued to try and make sense of their ongoing coronary risk, and in particular the controllability of their illness, long after communication with clinicians.
Conclusions: Understanding risk after AMI is a long-term process characterised by an internal dialogue in which patients translate the information from health professionals into their unique life situation. Clinicians need to follow up patients in the longer term to support patient learning and help them to manage their coronary risk with attention to everyday life context. Patients valued consistent, timely risk communication (ie. not necessarily in the immediate aftermath of AMI) delivered in a way that made sense to them.