Review ArticlePalliative Care in Advanced Heart Failure: An International Review of the Perspectives of Recipients and Health Professionals on Care Provision
Section snippets
Aims and Objectives
We systematically reviewed the literature on palliative care in advanced HF by exploring the evidence on: 1) patients’ understanding of their disease, their perceived needs and experiences of care provision; and 2) health professionals’ perspectives and experiences of care delivery.
Search Strategies
A literature search was conducted in 5 databases: Medline (1950–March 2010), Embase (1991–March 2010), Cinahl (1982–March 2010), Psycinfo (1970–March 2010), and Amed (1985–March 2010). Search terms included “chronic heart disease,” “advanced heart disease,” “palliative care,” “end-of-life care,” and “heart failure.” The inclusion criteria were:
- 1)
Research on the perspectives of patients or health professionals on advanced HF or the provision of palliative care in advanced HF.
- 2)
Care recipients who
Results
Our search strategy generated 1,047 citations of which 48 papers met our inclusion criteria. Twenty-six papers described patient perspectives, 18 examined health professionals’ perspectives, and 4 presented data derived from both patients and health professionals.
Breakdown of the methodology used in the 48 papers showed that 28 were qualitative, 16 quantitative, and 4 of mixed methods. Most quantitative studies originated from the United States (USA) (11/16) whereas most of the qualitative
Advanced HF Patient Perspectives (Table 1)
Studies exploring the patients’ perspectives were grouped according to the following themes: advanced HF patients’ understanding of their disease, their perceived needs, and views of their health and social care provision.
Although patients accepted that they had advanced HF,14, 15, 16 in 1 study many associated their symptoms with advancing age rather than the underlying progressive disease.17 There was little appreciation of the possible effects of HF on their lives, their prognosis, or an
Discussion
This review set out to explore the views of both recipients and providers of palliative care for advanced HF. Three themes were consistently identified by both patients and health professionals: a lack of continuity in the care provided to advanced HF patients, poor communication, and inconsistency in changing the emphasis of care from life prolonging to supportive.
Conclusions
This is the first review that has explored patient and provider perspectives on advanced HF care. It found consistent evidence that patients with advanced HF experienced shortcomings with the services currently provided. Likewise, health professionals from a range of relevant disciplines identified difficulties in providing coordinated care with current practice. Future research on development of palliative care service models for patients with advanced HF should consider ways to optimize
Acknowledgments
The authors acknowledge Marie Curie Cancer Care for funding this review.
Disclosures
None.
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