BACKGROUND: Although chronic heart failure (CHF) has a high mortality rate and symptom burden, and clinical guidance stipulates palliative care intervention, there is a lack of evidence to guide clinical practice for patients approaching the end of life. AIMS: (1) To formulate guidance and recommendations for improving end-of-life care in CHF; (2) to generate data on patients' and carers' preferences regarding future treatment modalities, and to investigate communication between staff, patients and carers on end-of-life issues. DESIGN: Semistructured qualitative interviews were conducted with 20 patients with CHF (New York Heart Association functional classification III-IV), 11 family carers, 6 palliative care clinicians and 6 cardiology clinicians. SETTING: A tertiary hospital in London, UK. RESULTS: Patients and families reported a wide range of end-of-life care preferences. None had discussed these with their clinicians, and none was aware of choices or alternatives in future care modalities, such as adopting a palliative approach. Patients and carers live with fear and anxiety, and are uninformed about the implications of their diagnosis. Cardiac staff confirmed that they rarely raise such issues with patients. Disease- and specialism-specific barriers to improving end-of-life care were identified. CONCLUSIONS: The novel, integrated data presented here provide three recommendations for improving care in line with policy directives: sensitive provision of information and discussion of end-of-life issues with patients and families; mutual education of cardiology and palliative care staff; and mutually agreed palliative care referral criteria and care pathways for patients with CHF.
BACKGROUND: Although chronic heart failure (CHF) has a high mortality rate and symptom burden, and clinical guidance stipulates palliative care intervention, there is a lack of evidence to guide clinical practice for patients approaching the end of life. AIMS: (1) To formulate guidance and recommendations for improving end-of-life care in CHF; (2) to generate data on patients' and carers' preferences regarding future treatment modalities, and to investigate communication between staff, patients and carers on end-of-life issues. DESIGN: Semistructured qualitative interviews were conducted with 20 patients with CHF (New York Heart Association functional classification III-IV), 11 family carers, 6 palliative care clinicians and 6 cardiology clinicians. SETTING: A tertiary hospital in London, UK. RESULTS:Patients and families reported a wide range of end-of-life care preferences. None had discussed these with their clinicians, and none was aware of choices or alternatives in future care modalities, such as adopting a palliative approach. Patients and carers live with fear and anxiety, and are uninformed about the implications of their diagnosis. Cardiac staff confirmed that they rarely raise such issues with patients. Disease- and specialism-specific barriers to improving end-of-life care were identified. CONCLUSIONS: The novel, integrated data presented here provide three recommendations for improving care in line with policy directives: sensitive provision of information and discussion of end-of-life issues with patients and families; mutual education of cardiology and palliative care staff; and mutually agreed palliative care referral criteria and care pathways for patients with CHF.
Authors: Scott D Solomon; Steve Zelenkofske; John J V McMurray; Peter V Finn; Eric Velazquez; George Ertl; Adam Harsanyi; Jean L Rouleau; Aldo Maggioni; Lars Kober; Harvey White; Frans Van de Werf; Karen Pieper; Robert M Califf; Marc A Pfeffer Journal: N Engl J Med Date: 2005-06-23 Impact factor: 91.245
Authors: H M Krumholz; R S Phillips; M B Hamel; J M Teno; P Bellamy; S K Broste; R M Califf; H Vidaillet; R B Davis; L H Muhlbaier; A F Connors; J Lynn; L Goldman Journal: Circulation Date: 1998-08-18 Impact factor: 29.690
Authors: J Malcom; O Arnold; Jonathan G Howlett; Anique Ducharme; Justin A Ezekowitz; Martin J Gardner; Nadia Giannetti; Haissam Haddad; George A Heckman; Debra Isaac; Philip Jong; Peter Liu; Elizabeth Mann; Robert S McKelvie; Gordon W Moe; Anna M Svendsen; Ross T Tsuyuki; Kelly O'Halloran; Heather J Ross; Errol J Sequeira; Michel White Journal: Can J Cardiol Date: 2008-01 Impact factor: 5.223
Authors: Neil Small; Sarah Barnes; Merryn Gott; Sheila Payne; Chris Parker; David Seamark; Salah Gariballa Journal: BMC Palliat Care Date: 2009-06-16 Impact factor: 3.234