Protocol for the development and validation of a measure of persistent psychological and emotional distress in cardiac patients : the cardiac distress inventory
- Jackson, Alun, Rogerson, Michelle, Le Grande, Michael, Thompson, David, Ski, Chantal, Alvarenga, Marlies, Amerena, John, Higgins, Rosemary, Raciti, Michela, Murphy, Barbara
- Authors: Jackson, Alun , Rogerson, Michelle , Le Grande, Michael , Thompson, David , Ski, Chantal , Alvarenga, Marlies , Amerena, John , Higgins, Rosemary , Raciti, Michela , Murphy, Barbara
- Date: 2020
- Type: Text , Journal article
- Relation: BMJ Open Vol. 10, no. 6 (2020), p.
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- Description: Introduction Distress is experienced by the majority of cardiac patients, yet no cardiac-specific measure of distress exists. The aim of this project is to develop and validate the Cardiac Distress Inventory (CDI). Using the CDI, health professionals will be able to identify key clusters of psychological, emotional and social concern to address with patients, postcardiac event. Methods and analysis An item pool will be generated through: identification of items by a multidisciplinary group of clinician researchers; review of generic and condition-specific distress measures; focus group testing with cardiac rehabilitation professionals; feedback from patients. The COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) criteria will be used to inform the development of the methodology for determining the CDI's psychometric properties. The item pool will be tested with 400 cardiac patients and responses subjected to exploratory factor analysis, Rasch analysis, construct validity testing and latent class analysis. Receiver operating characteristic analysis will be used to identify the optimal CDI cut-off score for distinguishing whether a person experiences clinically significant distress. Ethics and dissemination Approved by the Monash Health Human Research Ethics Committee (approval number - RES-19-0000631L-559790). The CDI will be made available to clinicians and researchers without charge. The CDI will be translated for use internationally. Study findings will be shared with cardiac patient support groups; academic and medical communities via publications and presentations; in the training of cardiac secondary prevention professionals; and in reports to funders. Authorship for publications will follow the uniform requirements for manuscripts submitted to biomedical journals. © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
- Authors: Jackson, Alun , Rogerson, Michelle , Le Grande, Michael , Thompson, David , Ski, Chantal , Alvarenga, Marlies , Amerena, John , Higgins, Rosemary , Raciti, Michela , Murphy, Barbara
- Date: 2020
- Type: Text , Journal article
- Relation: BMJ Open Vol. 10, no. 6 (2020), p.
- Full Text:
- Reviewed:
- Description: Introduction Distress is experienced by the majority of cardiac patients, yet no cardiac-specific measure of distress exists. The aim of this project is to develop and validate the Cardiac Distress Inventory (CDI). Using the CDI, health professionals will be able to identify key clusters of psychological, emotional and social concern to address with patients, postcardiac event. Methods and analysis An item pool will be generated through: identification of items by a multidisciplinary group of clinician researchers; review of generic and condition-specific distress measures; focus group testing with cardiac rehabilitation professionals; feedback from patients. The COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) criteria will be used to inform the development of the methodology for determining the CDI's psychometric properties. The item pool will be tested with 400 cardiac patients and responses subjected to exploratory factor analysis, Rasch analysis, construct validity testing and latent class analysis. Receiver operating characteristic analysis will be used to identify the optimal CDI cut-off score for distinguishing whether a person experiences clinically significant distress. Ethics and dissemination Approved by the Monash Health Human Research Ethics Committee (approval number - RES-19-0000631L-559790). The CDI will be made available to clinicians and researchers without charge. The CDI will be translated for use internationally. Study findings will be shared with cardiac patient support groups; academic and medical communities via publications and presentations; in the training of cardiac secondary prevention professionals; and in reports to funders. Authorship for publications will follow the uniform requirements for manuscripts submitted to biomedical journals. © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Unraveling the complexity of cardiac distress : a study of prevalence and severity
- Jackson, Alun, Rogerson, Michelle, Amerena, John, Smith, Julian, Hoover, Valerie, Alvarenga, Marlies, Higgins, Rosemary, Grande, Michael, Ski, Chantal, Thompson, David, Murphy, Barbara
- Authors: Jackson, Alun , Rogerson, Michelle , Amerena, John , Smith, Julian , Hoover, Valerie , Alvarenga, Marlies , Higgins, Rosemary , Grande, Michael , Ski, Chantal , Thompson, David , Murphy, Barbara
- Date: 2022
- Type: Text , Journal article
- Relation: Frontiers in Psychiatry Vol. 13, no. (2022), p.
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- Description: Introduction: While much research attention has been paid to anxiety and depression in people who have had a recent cardiac event, relatively little has focused on the broader concept of cardiac distress. Cardiac distress is a multidimensional construct that incorporates but extends beyond common mood disorders such as anxiety and depression. In the present study we assessed the prevalence, severity and predictors of a broad range of physical, affective, cognitive, behavioral and social symptoms of cardiac distress. This is the first study to investigate cardiac distress in this comprehensive way. Method: A sample of 194 patients was recruited from two hospitals in Australia. Eligible participants were those who had recently been hospitalized for an acute cardiac event. Data were collected at patients' outpatient clinic appointment ~8 weeks after their hospital discharge. Using a questionnaire developed through a protocol-driven 3-step process, participants reported on whether they had experienced each of 74 issues and concerns in the past 4 weeks, and the associated level of distress. They also provided sociodemographic and medical information. Regression analyses were used to identify risk factors for elevated distress. Results: Across the 74 issues and concerns, prevalence ratings ranged from a high of 66% to a low of 6%. The most commonly endorsed items were within the domains of dealing with symptoms, fear of the future, negative affect, and social isolation. Common experiences were “being physically restricted” (66%), “lacking energy” (60%), “being short of breath” (60%), “thinking I will never be the same again” (57%), and “not sleeping well” (51%). While less prevalent, “not having access to the health care I need,” “being concerned about my capacity for sexual activity,” and “being unsupported by family and friends” were reported as highly distressing (74, 64, and 62%) for those experiencing these issues. Having a mental health history and current financial strain were key risk factors for elevated distress. Conclusion and Implications: Specific experiences of distress appear to be highly prevalent in people who have had a recent cardiac event. Understanding these specific fears, worries and stressors has important implications for the identification and management of post-event mental health and, in turn, for supporting patients in their post-event cardiac recovery. Copyright © 2022 Jackson, Rogerson, Amerena, Smith, Hoover, Alvarenga, Higgins, Grande, Ski, Thompson and Murphy.
- Authors: Jackson, Alun , Rogerson, Michelle , Amerena, John , Smith, Julian , Hoover, Valerie , Alvarenga, Marlies , Higgins, Rosemary , Grande, Michael , Ski, Chantal , Thompson, David , Murphy, Barbara
- Date: 2022
- Type: Text , Journal article
- Relation: Frontiers in Psychiatry Vol. 13, no. (2022), p.
- Full Text:
- Reviewed:
- Description: Introduction: While much research attention has been paid to anxiety and depression in people who have had a recent cardiac event, relatively little has focused on the broader concept of cardiac distress. Cardiac distress is a multidimensional construct that incorporates but extends beyond common mood disorders such as anxiety and depression. In the present study we assessed the prevalence, severity and predictors of a broad range of physical, affective, cognitive, behavioral and social symptoms of cardiac distress. This is the first study to investigate cardiac distress in this comprehensive way. Method: A sample of 194 patients was recruited from two hospitals in Australia. Eligible participants were those who had recently been hospitalized for an acute cardiac event. Data were collected at patients' outpatient clinic appointment ~8 weeks after their hospital discharge. Using a questionnaire developed through a protocol-driven 3-step process, participants reported on whether they had experienced each of 74 issues and concerns in the past 4 weeks, and the associated level of distress. They also provided sociodemographic and medical information. Regression analyses were used to identify risk factors for elevated distress. Results: Across the 74 issues and concerns, prevalence ratings ranged from a high of 66% to a low of 6%. The most commonly endorsed items were within the domains of dealing with symptoms, fear of the future, negative affect, and social isolation. Common experiences were “being physically restricted” (66%), “lacking energy” (60%), “being short of breath” (60%), “thinking I will never be the same again” (57%), and “not sleeping well” (51%). While less prevalent, “not having access to the health care I need,” “being concerned about my capacity for sexual activity,” and “being unsupported by family and friends” were reported as highly distressing (74, 64, and 62%) for those experiencing these issues. Having a mental health history and current financial strain were key risk factors for elevated distress. Conclusion and Implications: Specific experiences of distress appear to be highly prevalent in people who have had a recent cardiac event. Understanding these specific fears, worries and stressors has important implications for the identification and management of post-event mental health and, in turn, for supporting patients in their post-event cardiac recovery. Copyright © 2022 Jackson, Rogerson, Amerena, Smith, Hoover, Alvarenga, Higgins, Grande, Ski, Thompson and Murphy.
- Murphy, Barbara, Zaman, Sarah, Tucker, Kim, Alvarenga, Marlies, Morrison-Jack, Jenni, Higgins, Rosemary, Le Grande, Michael, Nasis, Arthur, Jackson, Alun
- Authors: Murphy, Barbara , Zaman, Sarah , Tucker, Kim , Alvarenga, Marlies , Morrison-Jack, Jenni , Higgins, Rosemary , Le Grande, Michael , Nasis, Arthur , Jackson, Alun
- Date: 2021
- Type: Text , Journal article
- Relation: European Journal Cardiovascular Nursing Vol. 20, no. 7 (2021), p. 633-640
- Full Text: false
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- Description: Despite its demonstrated benefits, cardiac rehabilitation (CR) attendance, and completion is suboptimal, particularly in women. The aims of this study were (i) to develop and pilot test a women-only yoga-based CR programme (the Women's Yoga CR Programme WYCRP) (ii) to investigate programme acceptability and (iii) to investigate attendance and completion of the WYCRP and continuation to Phase III community-based CR. Women eligible for CR at a tertiary hospital in Melbourne, Australia were recruited. Over a 6-month period in 2019, they were offered the WYCRP or usual CR. The WYCRP involved attendance at a 1-h yoga session following the usual 1-h mixed-sex education session, over a 7-week period. Participants completed pre- and post-programme questionnaires and attended focus groups to assess programme acceptability. Rates of attendance, completion, and continuation for the WYCRP were recorded and compared to those for the standard CR programme offered in 2018. In total, 27 women were eligible for the study and attended the initial CR assessment. Of those, 22 (81%) attended the WYCRP, 1 (4%) attended usual CR, and 4 (15%) did not attend CR. Ratings of programme acceptability were consistently positive qualitative comments highlighted both physical and emotional benefits. While attendance at the WYCRP was not significantly higher than for usual CR the previous year (81% vs. 76% P = 0.40), CR completion, and continuation were (95% vs. 56% P = 0.02, and 72% vs. 12% P < 0.001, respectively). This pilot study has demonstrated that women-only yoga-based CR is appealing to women and can improve women's CR completion and continuation. These preliminary findings support further development of women-only and yoga-based CR options.
The cardiac distress inventory : a new measure of psychosocial distress associated with an acute cardiac event
- Jackson, Alun, Grande, Michael, Rogerson, Michelle, Ski, Chantal, Amerena, John, Smith, Julian, Hoover, Valerie, Alvarenga, Marlies, Higgins, Rosemary, Thompson, David, Murphy, Barbara
- Authors: Jackson, Alun , Grande, Michael , Rogerson, Michelle , Ski, Chantal , Amerena, John , Smith, Julian , Hoover, Valerie , Alvarenga, Marlies , Higgins, Rosemary , Thompson, David , Murphy, Barbara
- Date: 2022
- Type: Text , Journal article
- Relation: BMC Cardiovascular Disorders Vol. 22, no. 1 (2022), p.
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- Description: Background: Many challenges are posed by the experience of a heart attack or heart surgery which can be characterised as ‘cardiac distress’. It spans multiple psychosocial domains incorporating patients’ responses to physical, affective, cognitive, behavioural and social symptoms and experiences related to their cardiac event and their recovery. Although some measures of the psychological and emotional impacts of a cardiac event exist, none provides a comprehensive assessment of cardiac distress. To address this gap, the study aimed to develop a Cardiac Distress Inventory (CDI) using best practice in instrument design. Method: An item pool was generated through analysis of cognate measures, mostly in relation to other health conditions and through focus group and individual review by a multidisciplinary development team, cardiac patients, and end-users including cardiac rehabilitation co-ordinators. The resulting 144 items were reduced through further reviews to 74 for testing. The testing was carried out with 405 people recruited from three hospitals, through social media and by direct enrolment on the study website. A two-stage psychometric evaluation of the 74 items used exploratory factor analysis to extract the factors followed by Rasch analysis to confirm dimensionality within factors. Results: Psychometric analysis resulted in the identification of 55 items comprising eight subscales, to form the CDI. The subscales assess fear and uncertainty, disconnection and hopelessness, changes to roles and relationships, overwhelm and depletion, cognitive challenges, physical challenges, health system challenges, and death concerns. Validation against the Kessler 6 supports the criterion validity of the CDI. Conclusion: The CDI reflects a nuanced understanding of cardiac distress and should prove to be a useful clinical assessment tool, as well as a research instrument. Individual subscales or the complete CDI could be used to assess or monitor specific areas of distress in clinical practice. Development of a short form screening version for use in primary care, cardiac rehabilitation and counselling services is warranted. © 2022, The Author(s).
- Authors: Jackson, Alun , Grande, Michael , Rogerson, Michelle , Ski, Chantal , Amerena, John , Smith, Julian , Hoover, Valerie , Alvarenga, Marlies , Higgins, Rosemary , Thompson, David , Murphy, Barbara
- Date: 2022
- Type: Text , Journal article
- Relation: BMC Cardiovascular Disorders Vol. 22, no. 1 (2022), p.
- Full Text:
- Reviewed:
- Description: Background: Many challenges are posed by the experience of a heart attack or heart surgery which can be characterised as ‘cardiac distress’. It spans multiple psychosocial domains incorporating patients’ responses to physical, affective, cognitive, behavioural and social symptoms and experiences related to their cardiac event and their recovery. Although some measures of the psychological and emotional impacts of a cardiac event exist, none provides a comprehensive assessment of cardiac distress. To address this gap, the study aimed to develop a Cardiac Distress Inventory (CDI) using best practice in instrument design. Method: An item pool was generated through analysis of cognate measures, mostly in relation to other health conditions and through focus group and individual review by a multidisciplinary development team, cardiac patients, and end-users including cardiac rehabilitation co-ordinators. The resulting 144 items were reduced through further reviews to 74 for testing. The testing was carried out with 405 people recruited from three hospitals, through social media and by direct enrolment on the study website. A two-stage psychometric evaluation of the 74 items used exploratory factor analysis to extract the factors followed by Rasch analysis to confirm dimensionality within factors. Results: Psychometric analysis resulted in the identification of 55 items comprising eight subscales, to form the CDI. The subscales assess fear and uncertainty, disconnection and hopelessness, changes to roles and relationships, overwhelm and depletion, cognitive challenges, physical challenges, health system challenges, and death concerns. Validation against the Kessler 6 supports the criterion validity of the CDI. Conclusion: The CDI reflects a nuanced understanding of cardiac distress and should prove to be a useful clinical assessment tool, as well as a research instrument. Individual subscales or the complete CDI could be used to assess or monitor specific areas of distress in clinical practice. Development of a short form screening version for use in primary care, cardiac rehabilitation and counselling services is warranted. © 2022, The Author(s).
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