Health care decisions should include patients' health outcome goals and care preferences so
as to enable a unified set of individualized patient outcome goals, rather than disparate
disease-specific goals that do not reflect patient choice and commitment. This study utilizes
a skilled professional interview and a simple tablet-based tool to enable patient choice of
health behavior goals. The tool guides the patient to choose a specific, measurable,
attainable, realistic and time-based (SMART) goal. The hypothesis of this study is that the
implementation this patient choice tool will increase the likelihood of patient adherence to
the goal and increase patient self efficacy.
Patients who participate in the Women's Heart Clinic at Hadassah will be recruited to
participate in the study. Patients are to be included in this study if they have undergone
cardiovascular event (myocardial infarction, percutaneous coronary intervention, or stroke,)
had an active cardiac symptom (e.g. chest pain or arrhythmia) or had three or more active
risk factors (i.e. diabetes, hypertension, hyperlipidemia, peripheral artery disease, current
smoker, family history of premature coronary disease, gestational diabetes, pregnancy-induced
hypertension/pre-eclampsia, or obesity). Patients are excluded if they arere pregnant, have
type 1 diabetes, a psychiatric diagnosis that precluded participation, dementia, or if they
were under the care of another multi-disciplinary clinic. The Hadassah Heart Center for Women
follows a team-based approach, consisting of a cardiologist, nurse/coordinator, nutritionist,
physical therapist/exercise expert and psychologist. At the first visit, patients met with
all five professionals. The nurse/coordinator interviews the patient and assists in baseline
data collection. The physician obtains the history, conducted physical examinations and
determined cardiac care plans. The nutritionist assesses the patient's diet and assists the
patient with determining SMART (specific, measurable, achievable, realistic and time-bound)
goals using the table tool. The physical therapist/exercise expret performs an assessment of
physical activity capacity and behaviors,a 6 minute walk test, and assists the patient in
determining SMART goals for increased physical activity. The psychologist assessed patient
for active mental health concerns that would interfere with self-care, assisted her in
developing a plan to maximize self-care and developed a referral plan for patients who
required mental health intervention. Patient cases are reviewed in a multi-disciplinary
meeting after the visit and a comprehensive letter including specific recommendations from
each member of the team was sent to the patient (In Israel, letters are given to the patient
rather than directly to the referring physician.) Follow up appointments are scheduled
according to clinical indications.
Baseline data collection included age, medical history, country of birth, education, and
monthly income. Cardiac risk factors included the inclusion criteria as described above.
Health behaviors including nutrition behaviors, physical activity behaviors, smoking and
alcohol consumption are measured using a culturally-adapted translation of the Healthy Heart
Score and Mediterranean Diet Score. The patients fill out the Depression, Anxiety, Stress
Score and the Brief Experiential Avoidance Score, health self efficacy and overall quality of
life.
Patients will be followed by telephone/video conference at 1 and 2 months, return for follow
up visit at month 3, telephone/video conferecnce follow up will be done at months 4 and 5,
and the patient will return at month 6 for outcomes evaluation, which will include nutrition
and physical activity assessment, and health self efficacy, Health Heart Score, Brief
Experiential Avoidance Score, and Health self efficacy. In case of corona restrictions,
visits 3 and 6 may be done remotely as well