Health care professionals’ attitudes regarding palliative care for patients with chronic heart failure: an interview study

Abstract

BackgroundEven though struggling with similar symptom burden, patients with chronic heart failure (CHF) receive less palliative care than patients suffering from malignant diseases. Researchers have found that this might be related to lack of knowledge about palliative care, insufficient interprofessional communication as well as the cyclic course of disease which makes accurate prognosis difficult. However, research findings have shown that patients with CHF benefit from palliative care. As there are no studies for the German health care system this study aimed to assess health care professionals’ attitudes regarding palliative care of CHF patients in order to identify barriers and facilitators for this patient group and hence to develop recommendations for improvement of CHF patients’ access to palliative care in Germany.MethodProblem-centered interviews with 23 health care professionals involved in care of CHF patients (nurses: hospital, outpatient, heart failure, PC; physicians: hospital and resident cardiologists, general practitioners) were conducted and analysed according to Mayring’s qualitative content analysis.ResultsMost interviewees perceived a need for palliative care for CHF patients. Regarding barriers patients’, public’s, and professionals’ lack of knowledge of palliative care and CHF; shortcomings in communication and cooperation of different professional groups; inability of cardiology to accept medical limits; difficult prognosis of course of disease; and patients’ concerns regarding palliative care were described. Different attitudes regarding appropriate time of initiation of palliative care for CHF patients (late vs. early) were found. Furthermore, better communication and closer cooperation between different professional groups and medical disciplines as well as better education about palliative care and CHF for professionals, patients, and public were cited.ConclusionsPalliative care for CHF patients is a neglected topic in both practice and research and should receive more attention. Barriers to palliative care for CHF patients might be overcome by: better education for the public, patients, and professionals, closer cooperation between the different professional groups involved as well as development of a joint agreement regarding the appropriate time to administer palliative care to CHF patients.Trial registrationDRKS00007119.Electronic supplementary materialThe online version of this article (doi:10.1186/s12904-016-0149-9) contains supplementary material, which is available to authorized users.

Self-assessment and Screening for Palliative Care Need in Patients with Chronic Heart Failure

“…In contrast, the request for palliative care by the patient, relatives or the cardiology team was indicated rarely (5% each). This is in correspondence to previous studies demonstrating that cardiologists and their patients restrict palliative care to end-of-life care and have no specific ideas about integrating palliative care in earlier phases of the disease trajectories [15,16,20].…”

“…Various studies analyzed potential barriers responsible for this almost lacking integration of palliative care in patients with advanced cardiologic diseases [2,[15][16][17][18][19]. Potential reasons may be that the estimation of prognosis and trajectory of disease is considered more difficult than in cancer patients [2,17,18].…”

“…Potential reasons may be that the estimation of prognosis and trajectory of disease is considered more difficult than in cancer patients [2,17,18]. In contrast to oncology clinics, there are usually no established interactions, cooperation or communication structures between cardiology and palliative care specialists [2,15,19]. A limited understanding of the other specialist discipline hampers a professional collaborative approach to the specific patients` needs [15][16][17].…”

“…In contrast to oncology clinics, there are usually no established interactions, cooperation or communication structures between cardiology and palliative care specialists [2,15,19]. A limited understanding of the other specialist discipline hampers a professional collaborative approach to the specific patients` needs [15][16][17]. In the context of cardiologic diseases, palliative care is usually considered to be restricted to end-of-life care and cardiologists, but also the patients themselves and their family caregivers usually have no or only little knowledge about the potential benefits of palliative care in chronic heart failure patients [15,16,20].…”

“…A limited understanding of the other specialist discipline hampers a professional collaborative approach to the specific patients` needs [15][16][17]. In the context of cardiologic diseases, palliative care is usually considered to be restricted to end-of-life care and cardiologists, but also the patients themselves and their family caregivers usually have no or only little knowledge about the potential benefits of palliative care in chronic heart failure patients [15,16,20]. The most crucial reason seems to be the absence of criteria or trigger points defining the optimal time frame to initiate palliative care [2,16,17].…”