Barriers to goals of care discussions with hospitalized patients with advanced heart failure: feasibility and performance of a novel questionnaire

Abstract

AimsGood end‐of‐life communication and decision‐making are important to patients with advanced heart failure (HF) and their families, but their needs remain unmet. In this pilot study, we describe the feasibility and performance of a novel questionnaire aimed at identifying barriers and solutions to improve communication and decision‐making about goals of care for hospitalized patients with advanced HF.MethodsWe distributed questionnaires to staff cardiologists, cardiology trainees, and cardiology nurses who provide care for HF patients at a Canadian teaching hospital. The questionnaire asked about the importance of various barriers to goals of care discussions. It also asked participants to rank their willingness to engage in goals of care discussions and their views on other clinicians could engage in such discussions.ResultsOf 76 clinicians, 44 (58%) completed the questionnaire (median completion time, 17 min). Individual survey questions had few missing responses (0% to 2%) for questions about barriers to goals of care discussions. There was appreciable discrimination of the importance of different barriers (mean scores 2.2 to 6.0 on a 7‐point scale). Preliminary data suggest that clinicians perceive patient and family factors, such as difficulty accepting a poor prognosis, as the most important barriers preventing goals of care discussions.ConclusionsIn this pilot study, we have demonstrated the feasibility of a novel questionnaire to be used in a larger multi‐centre study of end‐of‐life HF care. Essential information will be obtained to inform the design and evaluation of interventions that seek to improve communication and decision‐making about goals of care with HF patients.

End-of-life situations in cardiology: a qualitative study of physicians' and nurses’ experience in a large university hospital

“…In this regard, in line with efforts to involve all healthcare professionals in improving end-of-life management across the spectrum of the healthcare pathway, it is essential that nurses be involved in the discussions regarding end-of-life decisions, and they may also be involved in the communication with the patient about end-of-life matters. According to a survey performed by Aleksova among cardiologists, cardiology trainees and cardiology nurses providing care for heart failure patients, nurses were more willing than physicians to initiate and engage in end-of-life discussions with patients [ 25 ]. In this same study, among non-physician clinicians, advanced practice nurses were deemed to be most acceptable to be involved in decision-making relating to goals of care [ 25 ].…”

“…According to a survey performed by Aleksova among cardiologists, cardiology trainees and cardiology nurses providing care for heart failure patients, nurses were more willing than physicians to initiate and engage in end-of-life discussions with patients [ 25 ]. In this same study, among non-physician clinicians, advanced practice nurses were deemed to be most acceptable to be involved in decision-making relating to goals of care [ 25 ]. However, it is important that the physicians do not shirk responsibility by having nurses play a role that the patient traditionally expects the physician to play.…”

Prognostic scores in advanced heart failure: where are we now and where are we going?

“…1,6,9 It is well known that comorbidities influence the pathophysiology, management, and prognosis of advanced HF, contributing to increased morbidity and mortality. [1][2][3][4][5][6] Murad et al 10 demonstrated that 60% of elderly patients with HF had at least 3 comorbidities, while only 2.5% of them had none. Renal and liver dysfunction significantly increases mortality associated with HF.…”

“…[1][2][3] It is estimated that HF affects approximately 38 million adults worldwide, including at least 15 million Europeans. 2,4 In Poland, about 600 000 to 700 000 people suffer from HF.…”

“…4 In patients with end -stage HF (advanced, stage D), treatment options are relevantly limited, morbidity is usually progressive, and survival is extremely short with a 1 -year mortality rate of approximately 50%. 6,7 In the REMATCH multicenter trial (Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure), patients with end -stage HF who were ineligible for heart transplantation showed a mortality rate of 75% in the first year and virtually no survival at 2 years of follow -up.…”