Healthy lifestyle behaviors after venous thromboembolism: The patient's perspective

Abstract

Background: Patients living after a venous thromboembolism (VTE) can experience a complex mix of physical and psychological symptoms. The complex nature of these symptoms creates challenges when designing effective rehabilitation programs for this patient group. Currently, there is a paucity of evidence on how to best rehabilitate these patients. A better understanding of the physical and psychological impact of VTE on the adoption of healthy lifestyle behaviors is needed to design an optimal rehabilitation program specifically for patients living post-VTE. This study is part of a larger initiative to develop an evidence-and theory-informed rehabilitation intervention targeting the psychological well-being and functional capacity in VTE survivors.

Objectives: The aim of this qualitative evidence synthesis was to identify, appraise, and synthesize the published evidence on barriers and facilitators to adopting healthy lifestyle behaviors post-VTE from the patient's perspective.

Methods: Four electronic databases, PubMED, EMBASE, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO, were searched from the inception of these databases to August 2024. One author screened, extracted, and appraised the literature, while a second author independently verified at least 20% of the sample at each stage. The quality of the included studies was assessed using the Critical Appraisal Skills Programme tool. A best-fit framework synthesis methodology was employed to synthesize the qualitative evidence addressing factors that affect VTE survivors' health behaviors, using the Theoretical Domains Framework (TDF) as the a priori framework and the Capability, Opportunity, Motivation-Behavior (COM-B) model to enhance knowledge and inform future intervention development. A mix of deductive coding, using the TDF and COM-B model, and inductive coding of data that did not fit the TDF was conducted. Relationships between the final set of themes were explored to understand patients' perspectives on the barriers and facilitators to adopting healthy lifestyle behaviors post-VTE. Results: Twenty-two papers reporting on 18 original studies met the eligibility criteria for inclusion. The barriers and facilitators identified were mapped to all 14 domains of the TDF, as well as the "Other" domain and all 6 of the COM-B constructs. The most common domains identified were "Knowledge," "Beliefs about Consequences," "Beliefs about Capabilities," "Emotion," and "Social and Professional Roles." From the patients' perspective, ongoing physical and psychological symptoms experienced after initial treatment for VTE act as significant barriers to engagement in healthy lifestyle behaviors. A perceived lack of knowledge and awareness of VTE and its potential longterm consequences among healthcare professionals was also identified as a significant barrier to engagement in and adoption of healthy lifestyle behaviors. Conclusion: Significant barriers to the adoption of healthy lifestyle behaviors exist after successful treatment of VTE. The main factors that influence the adoption of healthy lifestyle behaviors relate to knowledge of patients and healthcare professionals, the ongoing physical symptoms patients associate with VTE, the psychological impact of VTE, and patients' individual experiences of healthcare in terms of diagnosis, treatment, and ongoing care. Identifying barriers and facilitators to healthy lifestyle behaviors post-VTE is a necessary step in the development of a rehabilitation program specifically designed for patients post-VTE.