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Aim This paper is a report of a qualitative study conducted as part of a randomized controlled trial comparing a lay-facilitated angina management programme with usual care. Its aim was to explore participants' beliefs, experiences, and attitudes to the care they had received during the trial, particularly those who had received the angina management intervention. Background Angina affects over 50 million people worldwide. Over half of these people have symptoms that restrict their daily life and would benefit from knowing how to manage their condition. Design A nested qualitative study within a randomized controlled trial of lay-facilitated angina management. Method We conducted four participant focus groups during 2008; three were with people randomized to the intervention and one with those randomized to control. We recruited a total of 14 participants to the focus groups, 10 intervention, and 4 control. Findings Although recruitment to the focus groups was relatively low by comparison to conventional standards, each generated lively discussions and a rich data set. Data analysis demonstrated both similarities and differences between control and intervention groups. Similarities included low levels of prior knowledge about angina, whereas differences included a perception among intervention participants that lifestyle changes were more easily facilitated with the help and support of a lay-worker. Conclusion Lay facilitation with the Angina Plan is perceived by the participants to be beneficial in supporting self-management. However, clinical expertise is still required to meet the more complex information and care needs of people with stable angina. [ABSTRACT FROM AUTHOR]

furze g., cox h., morton v., chuang l.-h., lewin r.j.p., nelson p., carty r., norris h., patel n. & elton p. (2012) Randomized controlled trial of a lay-facilitated angina management programme. Journal of Advanced Nursing 68(10), 2267-2279. Abstract Aims. This article reports a randomized controlled trial of lay-facilitated angina management (registered trial acronym: LAMP). Background. Previously, a nurse-facilitated angina programme was shown to reduce angina while increasing physical activity, however most people with angina do not receive a cardiac rehabilitation or self-management programme. Lay people are increasingly being trained to facilitate self-management programmes. Design. A randomized controlled trial comparing a lay-facilitated angina management programme with routine care from an angina nurse specialist. Methods. Participants with new stable angina were randomized to the angina management programme (intervention: 70 participants) or advice from an angina nurse specialist (control: 72 participants). Primary outcome was angina frequency at 6 months; secondary outcomes at 3 and 6 months included: risk factors, physical functioning, anxiety, depression, angina misconceptions and cost utility. Follow-up was complete in March 2009. Analysis was by intention-to-treat; blind to group allocation. Results. There was no important difference in angina frequency at 6 months. Secondary outcomes, assessed by either linear or logistic regression models, demonstrated important differences favouring the intervention group, at 3 months for: Anxiety, angina misconceptions and for exercise report; and at 6 months for: Anxiety; Depression; and angina misconceptions. The intervention was considered cost-effective. Conclusion. The angina management programme produced some superior benefits when compared to advice from a specialist nurse. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study of the choices patients make when offered home-based or hospital-based cardiac rehabilitation. Background. In some countries, patients may be offered a choice of home-based or hospital-based cardiac rehabilitation. While evaluating a home-based programme, Road to Recovery, developed by the British Heart Foundation, we examined patients' experiences of being offered this choice. Methods. Interviews were conducted with 35 patients and 12 staff members delivering the pilot programme in five rehabilitation services during 2006-2008. Findings. While the staff members interviewed reported that all patients were given a clear choice between a home-based and hospital-based or community-based programme, this choice was less clear-cut in the patient interviews. When choice was offered, the choice of a home-based programme was often based on constraints rather than on being a positive choice. Obstacles patients faced in making the choice included lack of information on which to base a choice; inadequate systems of referral; insufficient appropriately trained staff; restricted choice of times to attend the hospital programmes; the geographical location of services and restrictive socio-economic factors (inflexible working hours, access to transport). Conclusion. The possibility of informed choice relies in the first instance on the availability and accessibility of appropriate services. Nurses need awareness and commitment to finding out about and overcoming obstacles that impede patient participation in cardiac rehabilitation. Only in this manner will it be possible to fulfil the calls in national and some international clinical guidelines for 'individualized' or 'menu-based' programmes tailored to specific patient needs. [ABSTRACT FROM AUTHOR]

goulding l., furze g. & birks y. (2010) Randomized controlled trials of interventions to change maladaptive illness beliefs in people with coronary heart disease: systematic review. Journal of Advanced Nursing 66(5), 946–961. Title. Randomized controlled trials of interventions to change maladaptive illness beliefs in people with coronary heart disease: systematic review. Aim. This paper is a report of a systematic review of randomized controlled trials of interventions to change maladaptive illness beliefs in people with coronary heart disease, and was conducted to determine whether such interventions were effective in changing maladaptive beliefs, and to assess any consequent change in coping and outcome. Background. An increasing body of evidence suggests that faulty beliefs can lead to maladaptive behaviours and, in turn, to poor outcomes. However, the effectiveness of interventions to change such faulty illness beliefs in people with coronary heart disease is unknown. Data sources. Multiple data bases were searched using a systematic search strategy. In addition, reference lists of included papers were checked and key authors in the field contacted. Review methods. The systematic review included randomized controlled trials with adults of any age with a diagnosis of coronary heart disease and an intervention aimed at changing cardiac beliefs. The primary outcome measured was change in beliefs about coronary heart disease. Results. Thirteen trials met the inclusion criteria. Owing to the heterogeneity of these studies, quantitative synthesis was not practicable. Descriptive synthesis of the results suggested that cognitive behavioural and counselling/education interventions can be effective in changing beliefs. The effects of changing beliefs on behavioural, functional and psychological outcomes remain unclear. Conclusion. While some interventions may be effective in changing beliefs in people with coronary heart disease, the effect of these changes on outcome is not clear. Further high quality research is required before firmer guidance can be given to clinicians on the most effective method to dispel cardiac misconceptions. [ABSTRACT FROM AUTHOR]