A comparative study of the palliative care needs of heart failure and cancer patients

Abstract

AimsStudies suggest that patients with advanced heart failure (HF) have unmet palliative care (PC) needs. However, many of these studies have been retrospective or based on patients receiving poorly coordinated ad hoc care. We aimed to demonstrate whether the PC needs of patients with advanced HF receiving specialist multidisciplinary coordinated care are similar to cancer patients deemed to have specialist PC needs; thereby justifying the extension of specialist PC services to HF patients. Methods and resultsThis was a cross-sectional comparative cohort study of 50 HF patients and 50 cancer patients, using quantitative and qualitative methods. Both patient cohorts were statistically indistinguishable in terms of symptom burden, emotional wellbeing, and quality-of-life scores. HF patients had good access to community and social support. HF patients particularly valued the close supervision, medication monitoring, ease of access to service, telephone support, and key worker provided at the HF unit. A small subset of patients had unmet PC needs. A palliative transition point is described. ConclusionHF patients should not be excluded from specialist PC services. However, the majority of their needs can be met at a HF unit. Recognition of the palliative transition point may be key to ensuring that end-of-life issues are addressed. The palliative transition point needs further evaluation.--

Transitions to palliative care for older people in acute hospitals: a mixed-methods study

“…61 Eight of the included articles were qualitative studies of patients, carers or health professionals. [61][62][63][64][65][66][67]72 One study was a mixed-methods comparative cohort study, 68 one a case study report, 69 one a critical discourse analysis 70 and one a non-empirical discussion piece. 71 Transition to palliative care was the main focus in only two of the included papers; 61,72 the remainder referred to transition only as a minor theme or as a component of the discussion.…”

“…Of the 12 papers included in the review, nine [61][62][63][64][65][66][67][68]72 provided evidence or discussion of patient and carer experiences of transitions. The overwhelming consensus was of fear and uncertainty when making the transition to palliative care.…”

“…O'Leary and colleagues 68 reported that early recognition of the palliative care transition point was key to ensuring that end-of-life issues were addressed. In a study by Bestall and colleagues, 65 primary care professionals described how late recognition of palliative care need, and referrals at a late stage, could have a negative impact on patients and on their relatives during bereavement.…”

“…61,65,68,70 O'Leary and colleagues 68 listed factors defining the palliative transition point in heart failure, including deterioration despite optimum support, increasing fatigue or functional dependence, low ejection fraction, recurring hospitalisations, emotional distress, carer fatigue and patient request. Bestall and colleagues 65 explored reasons for referral to specialist palliative care for both cancer and non-cancer conditions and highlight a lack of standardised criteria in the UK to determine when a referral should be triggered.…”

“…69 However, only four papers made any specific recommendations or developed any guidelines for improving the transition. 62,67,68,70 O'Leary and colleagues 68 discussed how the optimum transition should encompass planned and integrated transfer of patient information, the reiteration of patient preferences and the renegotiation of care goals. Recognition of the transition point was identified as key so that a collaborative care plan can be established, ensuring the most appropriate level of care.…”