Role of PC in HF—main themes
| Themes | Examples of comments |
|---|---|
| PC in HF has unique aspects (eg, disease chronicity) | “The HF patients often have a very different journey from cancer patients…symptoms tend to be long standing and chronic” “There is a role for end of life management but I'm not sure if that role is specialist palliative care as we do it in other situations” |
| Uncertainty about optimal timing for PC involvement due to unpredictable prognostication | “It can be very difficult to know when to become involved with this client group” “The most difficult problem we have with this group of patients is being able to assess that they really are end of life, as we do not have the resources to keep them on our case loads long term” “…unpredictability also makes people unsure when to refer” |
| “Shared care” is preferred as HF team frequently continues involvement | “…treatment of the underlying condition remains important throughout; therefore the heart failure CNSs remaining involved is essential” “Most of what we do is shared care rather than ‘transfer to’” |
| PC's role is to “support” HF team in complex symptom management, ACP discussions and other issues related to EOL | “…role of palliative care teams…is supporting the cardiology teams to be more comfortable with complex communications especially around resuscitation, ACP, etc” “We often just give advice and leave them in the hands of the heart failure specialist nurses” |
| Some situations require PC teams to lead and initiate intervention | “Heart failure CNS(s) vary in their confidence to manage symptoms & discussions surrounding EOLC issues & we sometimes need to take a lead with this” “…patients are reluctant to engage and cardiologists not sure when and how to do so” |
ACP, advance care planning; CNS, Clinical Nurse Specialists; EOL, end-of-life; HF, heart failure; PC, palliative care.