Experiences and management of fatigue in everyday life among adult patients living with heart failure: a systematic review of qualitative evidence.

BACKGROUND: Fatigue, a common and distressing symptom of heart failure, is a non-specific, invisible and subjective experience, which is difficult to describe and for which there are no effective interventions. Fatigue negatively impacts on patients' everyday life, prognosis and quality of life, therefore it is important that patients can manage, monitor and respond to changes in fatigue. To cope with fatigue patients may need or seek advice on self-management strategies.

OBJECTIVES: To synthesize the best available evidence on the experiences and management of fatigue in everyday life among adult patients with stable heart failure.

INCLUSION CRITERIA TYPES OF PARTICIPANTS: Adults with confirmed and stable heart failure.

PHENOMENA OF INTEREST: Studies exploring the experiences and management of fatigue in everyday life among adults with heart failure.

TYPES OF STUDIES: Qualitative studies focusing on qualitative data, including, but not limited to, designs within phenomenology, grounded theory or ethnography.

SEARCH STRATEGY: A three-step search strategy was used to identify published and unpublished qualitative studies from 1995 to 2014.

METHODOLOGICAL QUALITY: Studies that met the inclusion criteria were assessed by two independent reviewers for methodological validity using the standardized critical appraisal tools of the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI).

DATA EXTRACTION: Data was extracted from the five included studies using JBI-QARI.

DATA SYNTHESIS: Findings were identified and arranged according to the three research questions: patients' experiences of fatigue, impact of fatigue on everyday life and how patients' managed fatigue and its consequences in everyday life. Findings were pooled using JBI-QARI.

RESULTS: From the five included studies, 108 findings were derived and subsequently aggregated into 24 categories, which were finally meta-synthesized into five syntheses: "A pervasive and unignorable bodily experience" captured the patients' descriptions of fatigue experiences; "Limited performance of daily living and social activities" and "Loss of self-esteem, identity and intellectual function" aggregated the impact of fatigue on patients' everyday life; "Using protecting and restoring strategies according to the body barometer" and "A dynamic balance between accepting and struggling against fatigue" captured how patients managed fatigue and its consequences.

CONCLUSION: Three different types of bodily fatigue challenge patients with heart failure. Decreased physical capacity, unpredictability and fluctuating intensity are dominant features of fatigue experiences, which cause limitations in performing daily and social activities, increased dependency of others, and loss of self-esteem, identity and intellectual function. Patients' management of fatigue and its consequences is an ongoing process involving use of protective and restorative activities to handle the specific bodily fatigue. However it also relates to living constructively with fatigue by striking a balance between adjusting to and struggling against fatigue.

IMPLICATIONS FOR PRACTICE: Healthcare providers should be accountable to their patients, recognizing and taking into consideration patients' fatigue experiences and the meaning of fatigue, in order to provide optimal and individual care to their patients.

IMPLICATIONS FOR RESEARCH: Further qualitative research is needed to consider cultural factors of importance for managing fatigue in everyday life among patients with heart failure. Furthermore research should explore and test different kinds of physical and mind-body activities on the patients' functional capacity and wellbeing.