Non-pharmacological symptom self-management in non-malignant chronic disease: A scoping review

Patients with advanced non-malignant diseases experience pain, dyspnoea and fatigue, requiring a rehabilitation approach within palliative care.

To identify components of non-pharmacological interventions for symptom self-management for patients with non-malignant chronic disease.

This scoping review identifies: (1) systematic reviews of symptom self-management interventions for breathlessness, pain and fatigue in chronic lung, heart, renal and liver disease; (2) primary studies in low- and middle-income countries to identify intervention components, contextual factors, facilitators and barriers to symptom self-management. Six databases were searched, records exported to Rayyan and deduplicated. Following screening for inclusion, extraction was conducted. We conducted a narrative synthesis of intervention components and implementation factors, and content analysis of barriers and facilitators to interventions.

Thirty-one articles were included (21 systematic reviews and 10 primary studies). The populations studied had chronic lung disease (n = 19), heart disease (n = 12), chronic renal disease on dialysis (n = 2) and none had hepatic disease. The three most common intervention components were information, training and rehearsal for practical self-management activities and lifestyle support. Common patient barriers included motivation, adherence and health literacy, while facilitators encompassed knowledge, support and family involvement. The availability of healthcare workers can impact implementation, but remote access options should be considered.

Disease and management information for patients and their family members, along with support for home application, form the foundation for effective symptom self-management.Contribution: Symptom self-management for non-malignant chronic diseases is uncommon in low-resource settings. This review outlines the necessary components and implementation considerations.