title: 'Engage me in taking care of my heart': a grounded theory study on patient-cardiologist relationship in the hospital management of heart failure.
abstract: OBJECTIVE
  In approaching the study and practice of heart failure (HF) management, authors recognise that the patient-doctor relationship has a central role in engaging patients in their care. This study aims at identifying the features and the levers of HF patient engagement and suggestions for orienting clinical encounters.
  
  
  METHODS
  Using a grounded theory approach, we conducted 22 in-depth interviews (13 patients with HF, 5 physicians and 4 caregivers). Data were collected and analysed using open, axial and selective coding procedures according to the grounded theory principles.
  
  
  METHODS
  All interviews were conducted in an office in a university hospital located in a metropolitan area of Milan, Italy.
  
  
  METHODS
  The data comprised a total of 22 patient, hospital cardiologist and caregiver interviews. Patients aged ≥18 years with New York Heart Association (NYHA) Functional Class of II or III were eligible to take part. Patients were recruited primarily through their referral cardiologist.
  
  
  RESULTS
  The HF patient engagement process develops in four main phases that are characterised by different patients' emotional, cognitive and behavioural dynamics that contribute to shape the process of a patient's meaning making towards health and illness regarding their care. The emerging model illustrates that HF patient engagement entails a meaning-making process enacted by the patient after the critical event. This implies patients' ability to give sense to their care experience and to their disease, symptomatology and treatments, and their changes along their illness course. Doctors are recognised as crucial in fostering patients' engagement along all the phases of the process as they contribute to providing patients with self-continuity and give new meaning to their illness experience.
  
  
  CONCLUSIONS
  This study identifies the core experiential domains and the main levers involved in driving patients with HF to effectively engage in their disease management. The model emerging from this study may help clinicians think in a fresh way about encounters with patients and their role in fostering their patients' health engagement.
authors.affiliation: Faculty of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: Barello
authors.affiliation: Faculty of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.
authors.forename: Guendalina
authors.initials: G
authors.lastname: Graffigna
authors.affiliation: Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Vegni
authors.affiliation: Faculty of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.
authors.forename: Mariarosaria
authors.initials: M
authors.lastname: Savarese
authors.affiliation: Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Lombardi
authors.affiliation: Faculty of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.
authors.forename: A Claudio
authors.initials: AC
authors.lastname: Bosio
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D002309:Cardiology; D017028:Caregivers; D019468:Disease Management; D005260:Female; D066296:Grounded Theory; D006321:Heart; D006333:Heart Failure / Q000628:therapy*; D006761:Hospitals; D006801:Humans; D007407:Interviews as Topic; D007558:Italy; D008297:Male; D008505:Medical Staff, Hospital; D008875:Middle Aged; D010358:Patient Participation; D010817:Physician-Patient Relations; D010820:Physicians
keywords: QUALITATIVE RESEARCH; patient engagement