Interoception, the ability of the organism to sense, interpret, and regulate signals originating from within the body, plays an important role in how individuals perceive and respond to symptoms. However, there is scarce evidence on the role of interoception in the symptom experience of people with chronic conditions. To synthesize the role of interoception in the symptom experience of adults with a chronic condition. Systematic review. We searched PubMed, Psychinfo, Embase, CINAHL, and Science Citation Index-Expanded. We included primary research (all study designs) addressing our study aim, published between 2013 and 2021, and measuring at least one dimension of interoception. Any chronic condition and any symptom were included. No language limits were applied. Only the adult population was included. We included 18 quantitative studies investigating the relationship between three interoceptive dimensions (i.e., accuracy, sensibility, awareness) and condition-specific symptoms in 8 chronic conditions. People with chronic conditions had lower interoceptive accuracy than healthy controls. Higher interoceptive sensibility was associated with lower symptom severity/frequency. Higher interoceptive accuracy was associated with lower symptom severity/frequency in half of the studies, while the other half reported the opposite. Only one study explored interoceptive awareness. Interoceptive accuracy is lower in patients with chronic conditions. Higher interoceptive sensibility is associated with lower symptom severity/frequency, but this relationship is unclear when it comes to interoceptive accuracy and awareness.

Caregiver characteristics and behaviours are associated with patients’ and caregivers’ outcomes. However, there is scarce evidence on interventions aimed at improving caregiver contribution (CC) to patient self-care, caregiver self-efficacy, and caregiver preparedness in heart failure (HF). This study aims to evaluate the effect of Motivational Interviewing (MI) on CC to patient self-care, caregiver self-efficacy, and caregiver preparedness in HF. This is a secondary outcome analysis of MOTIVATE-HF randomized controlled trial. Caregivers of patients with HF were randomized into three arms: Arm 1 (MI for patients), Arm 2 (MI for patients and caregivers), and Arm 3 (standard care). The intervention consisted of one MI session plus three telephone contacts. Data were collected at baseline and after 3, 6, 9, and 12 months. A total of 510 patient and caregiver (median age 54 years, 76% females) dyads were enrolled, 235 caregivers and 238 patients completed the study until 12 months. Caregiver contribution to self-care maintenance and management and caregiver preparedness significantly improved over time, but without significant differences among the three arms. At 9 months, caregiver self-efficacy improved more in Arm 2 than Arm 3 [difference: 8.36, 95% confidence interval (CI) (3.13; 13.59), P = 0.001]. This improvement remained significant also at linear mixed model [ $β^$ = 1.39, 95% CI (0.02; 2.75), P = 0.046]. Motivational Interviewing did not improve CC to patient self-care and caregiver preparedness. However, it increased caregiver self-efficacy, which is known to be a powerful mediator of CC to self-care. Clinicaltrials.gov: NCT02894502.

Background: Patients with heart failure experience high symptom burden, which can be mitigated with adequate self-care. Caregiver contribution to self-care has been theorized to improve patient symptom burden. The mediating role of patient self-care in this relationship has not been tested yet. Objectives: The aim of this study was to test whether (a) caregiver contribution to self-care influences patient self-care, (b) patient self-care influences symptom burden, and (c) patient self-care mediates the relationship between caregiver contribution to self-care and symptom burden. Methods: In this study, the authors conducted a secondary analysis of the baseline and 3-month data from the MOTIVATE-HF trial, which enrolled 510 dyads (patient with heart failure and caregiver) in Italy. Multigroup confirmatory factor analysis was used to test measurement invariance. Autoregressive longitudinal path analysis with contemporaneous mediation was used to test our hypotheses. Results: On average, caregivers were 54 years old and mainly female, whereas patients were 72.4 years old and mainly male. Better caregiver contribution to self-care maintenance was associated with better patient self-care maintenance (β = 0.280, P < .001), which, in turn, was associated with lower symptom burden (β = −0.280, P < .001). Patient self-care maintenance mediated the effect of caregiver contribution to self-care maintenance on symptom burden (β = −0.079; 95% bias-corrected bootstrapped confidence interval, −0.130 to −0.043). Better caregiver contribution to self-care management was associated with better patient self-care management (β = 0.238, P = .006). The model significantly accounted for 37% of the total variance in symptom burden scores (P < .001). Conclusions: This study expands the situation-specific theory of caregiver contribution to heart failure self-care and provides new evidence on the role of caregiver contribution to self-care and patient self-care on symptom burden in heart failure.

Background: Better caregiver contribution to self-care in heart failure is associated with better patient outcomes. However, caregiver contribution to self-care is also associated with high anxiety and depression, poor quality of life, and poor sleep in caregivers. It is still unclear whether interventions that encourage caregivers to contribute more to patient self-care might increase caregivers' anxiety and depression and decrease their quality of life and sleep. Objective: The aim of this study was to assess the impact of a motivational interview intervention aimed at improving caregiver contribution to self-care in heart failure on caregivers' anxiety, depression, quality of life, and sleep. Methods: This is a secondary outcome analysis of the MOTIVATE-HF trial. Patients with heart failure and their caregivers were randomized into arm 1 (motivational interview to patients), arm 2 (motivational interview to patients and caregivers), and arm 3 (standard care). Data were collected between June 2014 and October 2018. The article has been prepared following the Consolidated Standards of Reporting Trials checklist. Results: A sample of 510 patient-caregiver dyads was enrolled. Over the year of the study, the levels of anxiety, depression, quality of life, and sleep in caregivers did not significantly change among the 3 arms. Conclusions: Motivational interview aimed at improving caregiver contribution to self-care does not seem to increase caregiver anxiety and depression, nor decrease their quality of life and sleep. Thus, such an intervention might be safely delivered to caregivers of patients with heart failure, although further studies are needed to confirm our findings.

Exploring how patients with acute and/or chronic illnesses experience symptoms. Using a phenomenological approach, interviews were conducted with patients to gain insights into their lived experiences and the meanings they attribute to symptoms. Phenomenological concepts of lifeworld, body and embodiment, intentionality, and existential anxiety provide lenses for examining the realities of patients' experiences. Three central themes emerged from the Ricoeur inspired analysis: Perception of an altered body presence, which highlights how illness transforms the perception of the body from a "silent" part of the self to an intrusive presence; Symptoms as a threat to existence, illuminating how symptoms confront patients with vulnerability, mortality, and existential uncertainty; and Loss and reclaiming of control, describing the ongoing struggle patients face between feelings of helplessness and efforts to regain autonomy in daily life.Symptoms are not merely indicators of illness but are intertwined with patients' identities and their sense of meaning in life. Insights emphasize the importance of addressing both the biological and existential dimensions of symptoms. Face-to-face clinical encounters offer a shared opportunity to create reflective spacesValidating coping strategies and supporting patients in reclaiming control, clinicians can nurture resilience, dignity, and a comprehensive approach to symptom (self)management.