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Title: An integrative review on facilitators and barriers in delivering and managing injectable therapies in chronic conditions: A part of the ACNAP project ‘injectable medicines among patients with cardiovascular conditions’
Authors: Lambrinou, Ekaterini 
Kyriakou, Martha 
Lakatamitou, Ioanna 
Angus, Neil J. 
Khatib, Rani 
Vellone, Ercole 
Barrowcliff, Abigail 
Hansen, Tina Birgitte 
Lee, Geraldine A. 
Major Field of Science: Medical and Health Sciences
Field Category: Clinical Medicine
Keywords: Adherence;Barriers;Chronic diseases;Facilitators;Injectable therapies;Perceptions;Self-injectable therapies
Issue Date: 1-Dec-2020
Source: European Journal of Cardiovascular Nursing, 2020, vol. 19, no. 8, pp. 663–680
Volume: 19
Issue: 8
Start page: 663
End page: 680
Journal: European Journal of Cardiovascular Nursing 
Abstract: Introduction: Although preventive health and therapeutics have benefited from advances in drug development and device innovation, translating these evidence-based treatments into real-world practice remains challenging. Aim: The current integrative review aims to identify facilitators and barriers and perceptions in delivering and managing injectable therapies from patient perspectives. Methods: An integrative review was conducted in the databases of PubMed, CINAHL, PsycINFO and Cochrane. Keywords were used “Injectable therapy”, “IV therapy”, “SC therapy”, “long term injectable therapies”, “self-administered injectable therapy”, “patients”, “caregivers”, “family”, “carers”, “facilitators”, “barriers”, “perspectives”, “needs”, “expectations”, “chronic disease”, “cardiovascular disease” linked with the words “OR” and “AND”. The search was limited from January 2000 to July 2019. Inclusion and exclusion criteria were used. Results: Twenty studies were identified from the literature search. Studies followed qualitative, quantitative methodology and mixed methods. Facilitators included: health improvement, prevention of disease complications, taking control of their disease, effectiveness of the medication and convenience in management. Barriers included: fear of needles, insulin will cause harm, poor perception of the benefits of injectable therapies on their quality of life, inconvenience in self-management, social stigma, impact on daily living, financial barriers, lack of education. Perceptions included: ‘treatment of last resort’, ‘life becomes less flexible’, ‘injectables were punishment/restriction’, ‘personal failure of self-management’. Conclusion: Evidence shows how to create effective communication and shared decision-making relationships to provide best possible care to patients who need injectable therapy and support for self-management. Future research might help guide response to the fears and barriers of the patients using patients’ perspectives.
ISSN: 1873-1953
DOI: 10.1177/1474515120939007
Rights: © Sage
Type: Article
Affiliation : Cyprus University of Technology 
Nicosia General Hospital 
American Heart Institute 
University of the Highlands and Islands 
Leeds Teaching Hospitals NHS Trust 
University of Leeds 
University of Rome Tor Vergata 
Zealand University Hospital 
University of Southern Denmark 
King's College London 
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