Integrated Review of Psychosocial and Behavioral Health Assessments and Interventions in Pulmonary Hypertension

• Published in: Nursing research (New York) Vol. 70; no. 2; pp. 150 - 161
• Main Authors: Von Visger, Tania T., Lee, Diana, Lyons, Amy, Chang, Yu-Ping
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 01-03-2021; Copyright Wolters Kluwer Health, Inc. All rights reserved; Lippincott Williams & Wilkins Ovid Technologies
• Subjects: Anxiety; Anxiety - prevention & control; Cognitive Behavioral Therapy - methods; Cognitive-behavioral factors; Connectedness; Disease management; Evidence-based medicine; Health Behavior; Health needs; Health Promotion - methods; Health status; Humans; Hypertension; Hypertension, Pulmonary - complications; Hypertension, Pulmonary - psychology; Hypertension, Pulmonary - therapy; Medical treatment; Mental depression; Palliative care; Primary Health Care - methods; Psychological distress; Psychosocial factors; Psychosocial intervention; Psychosocial well being; Pulmonary hypertension; Qualitative research; Quality assessment; Quality of Life; Selfmanagement; Sexual health; Systematic review
• ISSN: 0029-6562; 1538-9847
• DOI: 10.1097/NNR.0000000000000490

BACKGROUNDThe medical management of patients with pulmonary hypertension (PH) has advanced, with few evidence-based recommendations about psychosocial and behavioral health interventions. There is also a lack of comprehensive understanding of PH psychosocial and behavioral health needs. Some psychosocial and behavioral health interventions have been tested; however, there is a gap in systematic evaluation of nonpharmacological complementary approaches to augment PH management when addressing psychosocial and behavioral health needs.
OBJECTIVESThe objectives are to explore psychosocial and behavioral health needs and describe psychosocial and behavioral health interventions for patients with PH.
METHODSWe conducted an integrative systematic review of publications between January 1, 2010 and January 31, 2020, obtained from electronic databasesEMBASE, PubMED, CINAHL, Cochrane, PsycINFO, and Web of Science. The literature searches focused on empirical literature reporting psychosocial needs and psychosocial and behavioral health interventions for adult PH patients. We included peer-reviewed studies published in English. Search terms used in the study were“hypertension,” “pulmonary hypertension,” “psychosocial,” “depression,” “anxiety,” “quality of life,” “behavioral health,” “self-management,” “psychosocial intervention,” and “psychological distress.” Excluded were opinion and discussion publications, reviews, non-PH populations, and pediatric articles. We used the constant comparison method to guide the synthesis of reports applying the Joanna Briggs quality assessment guidelines.
RESULTSA total of 44 articles meeting the criteria were included for final consideration. We conducted an integrative systematic review of 27 quantitative studies, narrative synthesis of 10 qualitative studies, and seven psychosocial and behavioral health intervention studies. PH patients reported psychosocial needs such as financial, social connections, sexual health, and palliative care needs, as well as levels of psychological distress symptoms. The results from both quantitative and qualitative studies revealed similar overarching psychosocial and behavioral health conceptual categories. Patients described their ongoing needs in PH management by relying on their psychosocial and behavioral health capabilities to adjust to changes at each stage of disease progression. Patients had high levels of psychosocial and behavioral health needs requiring interventions beyond medical treatment.
DISCUSSIONPilot studies testing psychosocial and behavioral health interventions reported improvement in levels of anxiety and depression and health-related quality of life. Larger-scale studies are needed to advance this knowledge. Psychosocial and behavioral health interventions with cognitive-guided foci have the potential of meeting these unmet needs.