Other difficulties unique to palliative care (PC) in heart failure (HF)
| Themes | Examples of comments |
|---|---|
| Cardiologists are unfamiliar with identifying and managing palliative needs of patients with HF | “Advance care planning is the main challenge we have…cardiologists not sure when and how to do so” “…reluctance to refer patients because discussions (regarding prognosis) have never happened…” |
| Observations of reluctance by cardiologists to engage with PC profession | “Some heart failure clinicians easier to engage than others” “Having a cardiologist that ‘doesn't do palliative’ can make it more difficult to give help/advice to both patients and other team members” |
| Observations of patient reluctance to engage with PC profession for various reasons (eg, unaware of severity of their condition and stigma associated with use of PC) | “The main issue often…(is) prognostication and the patients’ perception of how ill they potentially are” “…HF patients often have a very different journey from cancer patients and the stigma surrounding palliative care and cancer at times persists” “…we have not had success in persuading patients to have PC assessment” |
| Insufficient PC resources to cope with additional workload | “…should be more involved with heart failure patients…the issue is how to do this most effectively with an already over stretched palliative care service…needs to be investment into palliative care services to provide this” “…we do not have the resources to keep them (HF patients) on our case loads long term…” |
| A need and desire by PC professionals to improve training in relevant PC skills for cardiology and vice versa for PC | “Two of the greatest barriers to good care by palliative services for patients with heart failure is…the limited knowledge that palliative specialist doctors and nurses have into the current best management of heart failure (esp. cardiac drugs and interventions such as biventricular pacemakers) not just to prolong life but to best manage symptoms caused by fluid overload and weak cardiac function…” “…in my experience the reluctance (by the cardiology team) to provide this (PC) is…lack of knowledge in symptom control and complex communication but with support from palliative care teams and education this can be improved” “General lack of confidence amongst PC CNSs around heart failure as opposed to malignancy” |
CNS, Clinical Nurse Specialists.