Frontiers in cardiovascular medicine · 2026
Discharge preparedness in chronic heart failure: a dyadic qualitative study of patient and clinician perspectives.
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Li Shan, Yang Ruonan, Zhu Zhaoying, Wang Wenqian, Ji Siying, Hou Yunying
Аннотация
BACKGROUND: Chronic heart failure (CHF) in China is characterized by high readmission rates, often linked to suboptimal discharge preparedness. Current discharge planning research predominantly relies on unilateral perspectives-focusing either solely on patient compliance or clinician workflows-thereby failing to capture the critical interactional misalignments that compromise care transitions. This study addresses this gap by employing a dyadic lens to expose the latent discrepancies between clinical priorities and patients' lived realities.
METHODS: A descriptive qualitative study was conducted at a tertiary hospital in urban China (November 2024-March 2025). Semi-structured interviews were conducted with 15 CHF patients and 6 cardiovascular clinicians. Data were analyzed using a directed content analysis approach underpinned by Spencer's biomedicalization framework. This theoretical orientation provided a structured methodology to decode the epistemic asymmetries and power dynamics characterizing the discharge process.
RESULTS: Four themes emerged: 1) The Disconnect in Medical Understanding (mechanistic misconceptions vs. educational barriers); 2) Fragile Self-Management in Daily Life (symptom-driven adherence vs. monitoring neglect); 3) Socio-Cultural Conflicts in Care (dietary non-compliance and contextual activity barriers); 4) Systemic Gaps in Support (familial support deficits and healthcare system shortfalls).
CONCLUSION: Discharge preparation deficiencies reflect bidirectional misalignments between patients' psychosocially embedded needs and clinicians' biomedical risk focus. An integrated intervention framework is proposed: 1) Patient-tier: Literacy-adapted education co-construction; 2) Family-tier: Caregiver crisis-response training; 3) System-tier: Digitally-enhanced nurse-led care coordination. Keywords: Chronic heart failure, Discharge planning, Health literacy, Patient-centered care, Transitional care.
METHODS: A descriptive qualitative study was conducted at a tertiary hospital in urban China (November 2024-March 2025). Semi-structured interviews were conducted with 15 CHF patients and 6 cardiovascular clinicians. Data were analyzed using a directed content analysis approach underpinned by Spencer's biomedicalization framework. This theoretical orientation provided a structured methodology to decode the epistemic asymmetries and power dynamics characterizing the discharge process.
RESULTS: Four themes emerged: 1) The Disconnect in Medical Understanding (mechanistic misconceptions vs. educational barriers); 2) Fragile Self-Management in Daily Life (symptom-driven adherence vs. monitoring neglect); 3) Socio-Cultural Conflicts in Care (dietary non-compliance and contextual activity barriers); 4) Systemic Gaps in Support (familial support deficits and healthcare system shortfalls).
CONCLUSION: Discharge preparation deficiencies reflect bidirectional misalignments between patients' psychosocially embedded needs and clinicians' biomedical risk focus. An integrated intervention framework is proposed: 1) Patient-tier: Literacy-adapted education co-construction; 2) Family-tier: Caregiver crisis-response training; 3) System-tier: Digitally-enhanced nurse-led care coordination. Keywords: Chronic heart failure, Discharge planning, Health literacy, Patient-centered care, Transitional care.