Introduction

Chronic heart failure (CHF) is a life-threatening syndrome with substantial morbidity and mortality [1]. Epidemiological data reveal that the prevalence rate of heart failure in adults worldwide ranges from 1% to 3% [2]. The burden of CHF extends beyond its high morbidity and mortality rates to encompass substantial healthcare resource utilization and economic costs. Patients with CHF experience frequent hospitalizations, with 40.5% of hospitalized cases having three or more admissions [3]. The readmission burden is particularly concerning, with 18.2% of patients requiring readmission within 30 days and 31.2% within 90 days [4]. These recurrent hospitalizations contribute to an estimated annual per-capita healthcare expenditure of $4,406.80, imposing a significant economic burden on healthcare systems [3].

Multiple factors contribute to the persistently high readmission rates among CHF patients. Research has identified that inadequate discharge planning, poor care transitions, non-adherence to medication regimens, insufficient patient education, lack of patient participation in the discharge process, and inadequate post-discharge follow-up are significant contributors to preventable readmissions [5,6]. These findings underscore the critical need for effective discharge planning as a cornerstone intervention to improve care transitions and reduce readmissions.

In response to this challenge, healthcare policy has increasingly emphasized the importance of structured discharge planning and transitional care. The Shandong province government in China has launched the Inpatient Discharge Planning Project to improve transitional care for chronic disease patients [7]. The American Heart Association (AHA) guidelines explicitly recommend that post-discharge systems of care be used to facilitate transitions to effective outpatient care for patients hospitalized with heart failure [5]. These guidelines emphasize comprehensive discharge planning, including patient education, medication reconciliation, early follow-up within 7–14 days, and multidisciplinary disease-management programs for high-risk patients [5,8].

Evidence demonstrates that patient-centered discharge planning can significantly reduce hospital length of stay, decrease readmission rates, and enhance patient satisfaction [9]. Furthermore, the effectiveness of discharge planning is substantially enhanced when patients are actively engaged as partners in the process, rather than serving as passive recipients of care instructions [10,11]. Patient participation is a multidimensional concept central to contemporary nursing practice. Cahill identified its core attributes through concept analysis, emphasizing the establishment of a nurse–patient relationship, the narrowing of information and knowledge gaps, a degree of power surrendered by the nurse, and active patient participation with positive benefit [12]. Sahlsten et al. similarly defined patient participation as comprising an established relationship, power-sharing, shared information, and active joint participation, with nurses assuming roles as empowerers and supportive facilitators [13]. More broadly, Paukkonen et al. emphasized that patient participation enables patients to get involved in and affect their own care in partnership with healthcare providers—a dynamic particularly important in populations with multimorbidity, as individualized participation is recognized as essential for meeting complex care challenges [14]. This concept has gained increasing recognition in healthcare policy and practice, exemplified by legislative reforms such as the revised Swedish Patient Act, which explicitly mandates patient participation to create a more balanced power dynamic between patients and healthcare providers [15]. It is important to note that the terms patient participation, patient involvement, and patient engagement are often used interchangeably in the literature [13,14]. Jerofke-Owen et al. concluded that, from a nursing perspective, all three describe a patient playing an active role in their healthcare, sharing the same core of establishing a mutual nurse–patient partnership toward empowerment. This review therefore treats them as conceptually equivalent and includes studies using any of these terms to describe patients’ active role in discharge planning [16].

However, its implementation in discharge planning has not been sufficiently improved in practice [5,17]. A qualitative metasummary and an observational study indicate that common barriers include healthcare professionals’ failure to elicit or encourage patients’ participation preferences, discharge decisions made unilaterally by clinicians without meaningful consultation with patients or families [18], inadequate patient education about discharge options [19]. These barriers may be particularly pronounced among patients with CHF, who face unique challenges that can hinder their participation in discharge planning.

Patients with CHF face unique challenges that may hinder their participation in discharge planning. The complexity of CHF management requires patients to navigate multiple medications, dietary restrictions, fluid management, and symptom monitoring [20]. Additionally, physical symptoms such as fatigue and dyspnea may also limit patients’ capacity to participate in lengthy discharge planning sessions [21]. Furthermore, cognitive impairment, which affects CHF patients, further complicates their ability to participate meaningfully in discharge discussions and retain critical self-care information [22]. Notably, the multimorbidity burden common in this population adds layers of complexity to discharge planning, which necessitates tailored, individualized participation strategies [23]. Given these multifaceted challenges, identifying effective strategies to promote meaningful patient participation in discharge planning is essential for this vulnerable population.

Some strategies have been proposed to promote patient participation in discharge planning for adults with CHF, such as provision of easy-to-understand information [17], participation in decision-making processes [17], coordination with multidisciplinary teams [24], use of teach-back methods [25], and shared goal-setting [26]. However, the evidence base remains fragmented across diverse sources and study designs. Additionally, no scoping review has specifically focused on synthesizing strategies to promote patient participation in discharge planning for CHF patients and describing their reported outcomes.

Methods

Stage 2: Identifying relevant studies

Search strategy.

In collaboration with a health sciences librarian, the following 20 databases and websites will be searched from inception: BMJ Best Practice, Joanna Briggs Institute (JBI), UpToDate, Scottish Intercollegiate Guidelines Network (SIGN), National Institute for Health and Care Excellence (NICE), National Guideline Clearinghouse (NGC), Registered Nurses’ Association of Ontario (RNAO) database, Guidelines International Network (GIN), Heart Failure Society of America (HFSA), Medlive, MedSci, PubMed, Web of Science, Cochrane Library, CINAHL, Embase, Chinese Biomedical Literature Database (SinoMed), WANFANG DATA, China National Knowledge Infrastructure (CNKI) database and CQVIP. Reference lists of included studies will be manually searched in addition to the above databases.

The search strategy developed for PubMed (Table 1) will be adapted for other databases with appropriate modifications to database-specific syntax and controlled vocabulary.

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Table 1. Search strategy in PubMed.

https://doi.org/10.1371/journal.pone.0348367.t001

Stage 5: Collating, summarizing and reporting the results

Phase 1 – Quantitative mapping of study characteristics.

Descriptive statistics will be used to summarize key characteristics including publication year, country, study design, sample characteristics, healthcare setting, types of patient participation strategies, and reported outcome measures.

Phase 2 – Thematic synthesis of participation strategies and outcomes.

Thematic synthesis will follow framework described by Thomas and Harden [33]. The analysis will proceed through the following steps:

1. (1). two reviewers will independently code the extracted textual data line-by-line.
2. (2). related codes will be grouped and developed into descriptive themes that closely reflect the content of the included studies.
3. (3). descriptive themes will be interpreted and abstracted into analytical themes, examined against the conceptual definition of patient participation—encompassing information exchange, shared decision-making, goal-setting, empowerment, and collaborative partnership—to generate deeper insights beyond the original studies.

Discrepancies between reviewers at any stage will be resolved through discussion or, if necessary, adjudication by a third reviewer. The resulting analytical themes will directly inform the application of the PAGER framework.

Phase 3 – Application of the PAGER framework.

The findings will be presented and interpreted using the PAGER framework, which includes organizing evidence into Patterns, Advances, Gaps, Evidence for practice, and Research recommendations [32]. The five components and their operational definitions within this review are presented in Table 2.

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Table 2. Application of the PAGER framework in this scoping review.

https://doi.org/10.1371/journal.pone.0348367.t002

Final findings will be presented as an integrated narrative synthesis accompanied by thematic diagrams, summary tables, and a visual evidence map, in accordance with PRISMA-ScR reporting requirements.

Discussion

This protocol outlines the first scoping review to systematically map evidence on patient participation in discharge planning for adults with CHF. While discharge planning for adults with CHF has been extensively studied, no review has specifically synthesized strategies to enhance patient participation and their associated outcomes—a critical gap given the recognized disconnect between policy mandates for participation and actual clinical practice.

Conclusion

CHF imposes substantial burden through high readmission rates and healthcare costs. While discharge planning is well-established for improving transitions, the critical role of patient participation has not been comprehensively synthesized. This scoping review will systematically map available evidence on strategies promoting patient participation in discharge planning for adults with CHF and describe reported outcomes.

By following rigorous JBI methodology and PRISMA-ScR guidelines, this review will provide a comprehensive evidence map to inform clinical practice, organizational policy, and future research. The findings will address an important knowledge gap with practical implications for improving patient-centered discharge planning for this vulnerable population.

Upon completion, results will be disseminated through peer-reviewed publication and stakeholder engagement to maximize impact. This work aims to advance patient-centered care by ensuring individuals with CHF are meaningfully engaged as partners in their discharge planning, ultimately leading to better outcomes and more efficient healthcare resource use.

Supporting information