Pilot Study of Palliative Care Consultation in Patients with Advanced Heart Failure Referred for Cardiac Transplantation

Schwarz, Ernst R.; Baraghoush, Afshan; Morrissey, Ryan P.; Shah, Ankit B.; Shinde, Ashwin; Phan, Anita; Bharadwaj, Parag

doi:10.1089/jpm.2011.0256

Cited by 68 publications

(74 citation statements)

References 12 publications

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“…111 Studies suggest that patients with advanced HF managed with a palliative care team may report improved symptom control with lower total opiate requirements. 112 Patients comanaged by primary and palliative care teams report better QOL (general health, emotional and social functioning) and less depression than their counterparts, as shown in a study of women treated for advanced breast or gynecological cancers. 113 A study surveying patients enrolled in one hospice program reported good or very good QOL during their admission, although this was not always the case at initial presentation.…”

Section: Patient Outcomesmentioning

confidence: 97%

Palliative Care and Cardiovascular Disease and Stroke: A Policy Statement From the American Heart Association/American Stroke Association

Braun¹,

Grady²,

Kutner³

et al. 2016

Circulation

199

143

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AbstrAct:The mission of the American Heart Association/American Stroke Association includes increasing access to high-quality, evidencebased care that improves patient outcomes such as health-related quality of life and is consistent with the patients' values, preferences, and goals. Awareness of and access to palliative care interventions align with the American Heart Association/American Stroke Association mission. The purposes of this policy statement are to provide background on the importance of palliative care as it pertains to patients with advanced cardiovascular disease and stroke and their families and to make recommendations for policy decisions. Palliative care, defined as patient-and family-centered care that optimizes health-related quality of life by anticipating, preventing, and treating suffering, should be integrated into the care of all patients with advanced cardiovascular disease and stroke early in the disease trajectory. Palliative care focuses on communication, shared decision making about treatment options, advance care planning, and attention to physical, emotional, spiritual, and psychological distress with inclusion of the patient's family and care system. Our policy recommendations address the following: reimbursement for comprehensive delivery of palliative care services for patients with advanced cardiovascular disease and stroke; strong payerprovider relationships that involve data sharing to identify patients in need of palliative care, identification of better care and payment models, and establishment of quality standards and outcome measurements; healthcare system policies for the provision of comprehensive palliative care services during hospitalization, including goals of care, treatment decisions, needs of family caregivers, and transition to other care settings; and health professional education in palliative care as part of licensure requirements.

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Section: Patient Outcomesmentioning

confidence: 97%

Palliative Care and Cardiovascular Disease and Stroke: A Policy Statement From the American Heart Association/American Stroke Association

Braun¹,

Grady²,

Kutner³

et al. 2016

Circulation

199

143

View full text Add to dashboard Cite

show abstract

“…2,3,19,35 From a total of 108 citations identified by our literature search, we retained 5 articles pertaining to end-of-life issues. 35,[38][39][40][41] This literature was very limited: studies were small (14-68 persons), and 4 were from single sites (3 from the same hospital). Two studies involved exclusively DT patients.…”

Section: Device Deactivation and Other End-of-life Issuesmentioning

confidence: 99%

“…38,39 A 2003 to 2009 study (≈50% DT) found that none of the care directives of MCS patients in medical charts specifically mentioned the circumstances in which MCS might be deactivated. 40 However, requests to terminate MCS were not uncommon: at the same center from 2003 to 2009, such requests were made for 21% of recipients (50% of these DT), usually by surrogate decision makers (85% of the time), because the patients no longer had decision-making capacity.…”

Section: Device Deactivation and Other End-of-life Issuesmentioning

confidence: 99%

Challenge of Informing Patient Decision Making

Boothroyd

Lambert

Ducharme

et al. 2014

Circ: Cardiovascular Quality and Outcomes

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“…Other studies report various unmet palliative care needs in patients with advanced heart failure [6,7]. Although some studies suggest beneficial effects of palliative care consultation [8][9][10][11][12], less than 10% of patients with heart failure receive palliative care today [13,14].…”

Section: Introductionmentioning

confidence: 99%

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

Ehlert¹,

Kodolitsch²,

Ullrich³

et al. 2017

J Palliat Care Med

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Objective: Patients with chronic heart failure (CHF) rarely receive palliative care today. Methods:In a cross-sectional pilot study we evaluated feasibility of self-assessment and physician-directed screening for palliative care need in CHF patients. Patients answered German versions of the "Minimal Documentation system for patients in palliative care" (MIDOS), "Distress-Thermometer" (DT), and the "Patient Health Questionnaire" (PHQ4). A modified version of the "Five-Item Palliative Care Screening Tool" was used to screen for palliative care need by the treating cardiologists.Results: 218 patients were asked to participate and 148 (67%) completed all questionnaires. Median symptom burden (MIDOS) was 7 out of 30 points (SD 4.868), overall wellbeing was two of 5 (SD 0.902), and median distress score was 6 of 10 (SD 2.318). Most frequent moderate or severe symptoms were dyspnea (52%), weakness (51%), and tiredness (49%). Significant distress (DT score>5) was indicated by 106 patients (72%). Exhaustion (79%), sleeping problems (75%), and problems with breathing (69%) were most frequent problems. Only 11% and 14% of patients presented with significant anxiety and depression, respectively (PHQ4-score>3).Palliative care need was scored with mean 6.8 out of 12 points (SD 2.223). Using a cut-off value of >5, 113 patients (76%) would have needed palliative care. Objective parameters for palliative care need (symptom burden 43%, distress 68%, decision-making 67%) were indicated, but request for palliative care by the patients, their relatives (5%) or the cardiology team (5%) was rare. Symptom burden and palliative care screening showed significant, but not clinically relevant interaction. Conclusion:This pilot study, feasibility of palliative care self-assessment and the modified screening instrument could be demonstrated in CHF patients. For comprehensive screening, both perspectives have to be included. First results indicate significant symptom burden, psychological distress and a high need for additional palliative care in CHF patients.

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Pilot Study of Palliative Care Consultation in Patients with Advanced Heart Failure Referred for Cardiac Transplantation

Cited by 68 publications

References 12 publications

Palliative Care and Cardiovascular Disease and Stroke: A Policy Statement From the American Heart Association/American Stroke Association

Palliative Care and Cardiovascular Disease and Stroke: A Policy Statement From the American Heart Association/American Stroke Association

Challenge of Informing Patient Decision Making

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

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