Discharge preparedness in chronic heart failure: a dyadic qualitative study of patient and clinician perspectives.

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.