Introduction: The aim of this study was to explore the perspectives of health care professionals (HCPs) on the transition of heart failure (HF) patients to a palliative care approach. Method: Qualitative data were generated from 24 HCPs specializing in cardiology, care for the elderly, and palliative care. Data were analyzed using the principles of thematic analysis. Results: Emergent themes related to the unpredictable trajectory of HF, causing prognostic ambiguity; the use of structured pathways in end-of-life decision making; and comparison of HF and cancer patients in terms of their requirements and access to high-quality palliative care. Conclusion: There is a need for both established prognostic guidelines and further education to develop the communication skills to facilitate end-of-life discussions with HF patients.
Addington-HallJ.M., HigginsonI.J., editors. Palliative care for non-cancer patients.New York: Oxford University Press; 2001.
2.
CoventryP.A., GrandeG.E., RichardsD.A.Prediction of appropriate timing of palliative care for older adults with non-malignant life-threatening disease: a systematic review.Age Ageing2005; 34(3): 218–227.
3.
StuartB.The nature of heart failure as a challenge to the integration of palliative care services.Curr Opin Support Palliat Care2007; 1(4): 249–254.
4.
Department of Health.Coronary heart disease National Service Framework.London: Author; 2000.
5.
UnderwoodJ.C.E.General and systematic pathology.4th ed.London: Elsevier; 2004.
6.
Royal College of Physicians.Chronic heart failure: national clinical guideline for diagnosis and management in primary and secondary care.London: Author; 2003.
7.
Department of Health.End of life care strategy for England.London: Author; 2008.
WilkinsonS.Factors which influence how nurses communicate with cancer patients.J Adv Nurs1991; (16): 677–688.
10.
DukeS., BaileyC.Communication: patient and family. In: PayneS., SeymourJ., IngletonC., editors. Palliative care nursing: principles and evidence for practice.Berkshire: Open University Press; 2008: 121–144.
11.
SegalD.I., O'HanlonD., RahmanN.Incorporating palliative care into heart failure management: a new model of care.Int J Palliat Nurs2005; 11(3): 135–136.
12.
GottM., GardinerC., SmallN.Barriers to advance care planning in chronic obstructive pulmonary disease.Palliat Med2009; 23(7): 642–648.
13.
General Medical Council.Treatment and care towards the end of life: good practice in decision making.London: Author; 2010.
14.
QuillT.E.Initiating end-of-life discussions with seriously ill patients: addressing the “elephant in the room.”JAMA2000; 284(19): 2502–2507.
15.
GauthierD.M.Challenges and opportunities: communication near the end of life.Medsurg Nurs2008; 17(5): 291–296.
16.
WingateS., WiegandD.L.End-of-life care in the critical care unit for patients with heart failure.Crit Care Nurse2008; 28(2): 84–95.
17.
ClaytonJ.M., ButowP.N., TattersallM.H.N.When and how to initiate discussion about prognosis and end-of-life issues with terminally ill patients.J Pain Symptom Manag2005; 30(2): 132–144.
18.
HardingR., SelmanL., BeynonT.Meeting the communication and information needs of chronic heart failure patients.J Pain Symptom Manag2008; 36(2): 149–156.
19.
JablonskiA.Palliative care: misconceptions that limit access for patients with chronic renal disease.Semin Dial2008; 21(3): 206–209.
20.
ZapkaJ.G., HennessyW., CarterR.E.End-of-life communication and hospital nurses: an educational pilot.J Cardiovasc Nurs2006; 21(3): 223–231.
21.
SelmanL., HardingR., BeynonT.Improving end-of-life care for patients with chronic heart failure: “Let's hope it'll get better, when I know in my heart of hearts it won't.”Heart2007; 93(8): 963–967.
22.
RatcliffeT.Healthcare providers need to improve communication with patients who have heart failure.Br J Gen Pract2007; 57(536): 180–182.
23.
GillickM.R.Decision making near life's end: a prescription for change.J Palliat Med2009; 12(2): 121–125.
24.
LevyW.C., MozaffarianD., LinkerD.T.The Seattle Heart Failure Model: prediction of survival in heart failure.Circulation2006; 113(11): 1424–1433.
25.
WardC.The need for palliative care in the management of heart failure.Heart2002; 87(3): 294–298.
EdmondsP., BurmanR., PrenticeW.End of life care in the acute hospital setting.BMJ2009; 339: b5048.
28.
The Liverpool Care Pathway for the dying patient.Liverpool: Marie Curie Palliative Care Institute, Liverpool University; 2007.
29.
BaileW.F., BuckmanR., LenziR.SPIKES: a six-step protocol for delivering bad news: application to the patient with cancer.Oncologist2000; 5(4): 302–311.
30.
RabowM.W., McPheeS.J.Beyond breaking bad news: how to help patients who suffer.West J Med1999; 171(4): 260–263.
31.
WorkmanS.A communication model for encouraging optimal care at the end of life for hospitalized patients.QJM2007; 100(12): 791–797.
32.
LienC., GillespieN., StruthersA.Heart failure in frail elderly patients: diagnostic difficulties, co-morbidities, polypharmacy and treatment dilemmas.Eur J Heart Failure2002; 4(1): 91–98.
33.
National Health Service.Connected: national communication skills training.London: Department of Health, Author; 2009.
34.
RogersA.E., Addington-HallJ.M., AberyA.J.Knowledge and communication difficulties for patients with chronic heart failure: qualitative study.BMJ2000; 321(7261): 605–607.
35.
SolanoJ.P., GomesB., HigginsonI.J.A comparison of symptom prevalence in far advanced cancer, AIDS, heart disease, chronic obstructive pulmonary disease and renal disease.J Pain Symptom Manag2006; 31(1): 58–69.
36.
GardinerC., GottM., SmallN.Living with advanced chronic obstructive pulmonary disease: patients’ concerns regarding death and dying.Palliat Med2009; 23(8): 691–697.
37.
InnesS., PayneS.Advanced cancer patients’ prognostic information preferences: a review.Palliat Med2009; 23(1): 29–39.
38.
RulandC.M.Improving patient outcomes by including patient preferences in nursing care. In: American Medical Informatics Association (AMIA). Proceedings of the AMIA annual symposium, 1998. Bethesda (MD): Author; 1998.
39.
ParkerS.M., ClaytonJ.M., HancockK.A systematic review of prognostic/end-of-life communication with adults in the advanced stages of a life-limiting illness: patient/caregiver preferences for the content, style, and timing of information.J Pain Symptom Manag2007; 34(1): 81–93.
40.
DavidsonP.M.Difficult conversations and chronic heart failure: do you talk the talk or walk the walk?Curr Opin Support Palliat Care2007; 1(4): 274–278.
41.
GottM., SmallN., BarnesS.Older people's views of a good death in heart failure: implications for palliative care provision.Soc Sci Med2008; 67: 1113–1121.
SchofieldP., CareyM., LoveA.“Would you like to talk about your future treatment options?” Discussing the transition from curative cancer treatment to palliative care.Palliat Med2006; 20(4): 397–406.
44.
GordonG.H.Care not cure: dialogues at the transition.Patient Educ Couns2003; 50(1): 95–98.
