Interventions for the prevention of adrenal crisis in adults with primary adrenal insufficiency: a systematic review

Lisa M Shepherd, Kelly Ann Schmidtke, Jonathan M Hazlehurst, Eka Melson, Janine Dretzke, Noel Hawks, Wiebeke Arlt, Abd A Tahrani, Amelia Swift, Debbie M Carrick-Sen

Research output: Contribution to journalArticlepeer-review

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Abstract

Objective: The incidence of adrenal crisis (AC) remains high, particularly for people with primary adrenal insufficiency, despite the introduction of behavioural interventions. The present study aimed to identify and evaluate available evidence of interventions aiming to prevent AC in primary adrenal insufficiency.

Design: This study is a systematic review of the literature and theoretical mapping.

Methods: MEDLINE, MEDLINE in Process, EMBASE, ERIC, Cochrane CENTRAL, CINAHL, PsycINFO, the Health Management Information Consortium and trial registries were searched from inception to November 2021. Three reviewers independently selected studies and extracted data. Two reviewers appraised the studies for the risk of bias.

Results: Seven observational or mixed methods studies were identified where interventions were designed to prevent AC in adrenal insufficiency. Patient education was the focus of all interventions and utilised the same two behaviour change techniques, 'instruction on how to perform a behaviour' and 'pharmacological support'. Barrier and facilitator themes aiding or hindering the intervention included knowledge, behaviour, emotions, skills, social influences and environmental context and resources. Most studies did not measure effectiveness, and assessment of knowledge varied across studies. The study quality was moderate.

Conclusion: This is an emerging field with limited studies available. Further research is required in relation to the development and assessment of different behaviour change interventions to prevent AC.

Original languageEnglish
Pages (from-to)S1-S20
JournalEuropean Journal of Endocrinology
Volume187
Issue number1
DOIs
Publication statusPublished - 1 Jun 2022

Keywords

  • Addison Disease/prevention & control
  • Adult
  • Humans
  • Patient Education as Topic

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