scholarly journals Palliative care for people living with heart failure: European Association for Palliative Care Task Force expert position statement

2019 ◽  
Vol 116 (1) ◽  
pp. 12-27 ◽  
Author(s):  
Piotr Z Sobanski ◽  
Bernd Alt-Epping ◽  
David C Currow ◽  
Sarah J Goodlin ◽  
Tomasz Grodzicki ◽  
...  
Keyword(s):  
Heart Failure ◽  
Palliative Care ◽  
Task Force ◽  
Position Statement ◽  
Substantial Improvement ◽  
Assessment Tools ◽  
Spiritual Needs ◽  
Emotional Healing ◽  
Incurable Disease ◽  
Advance Care

Abstract Contrary to common perception, modern palliative care (PC) is applicable to all people with an incurable disease, not only cancer. PC is appropriate at every stage of disease progression, when PC needs emerge. These needs can be of physical, emotional, social, or spiritual nature. This document encourages the use of validated assessment tools to recognize such needs and ascertain efficacy of management. PC interventions should be provided alongside cardiologic management. Treating breathlessness is more effective, when cardiologic management is supported by PC interventions. Treating other symptoms like pain or depression requires predominantly PC interventions. Advance Care Planning aims to ensure that the future treatment and care the person receives is concordant with their personal values and goals, even after losing decision-making capacity. It should include also disease specific aspects, such as modification of implantable device activity at the end of life. The Whole Person Care concept describes the inseparability of the physical, emotional, and spiritual dimensions of the human being. Addressing psychological and spiritual needs, together with medical treatment, maintains personal integrity and promotes emotional healing. Most PC concerns can be addressed by the usual care team, supported by a PC specialist if needed. During dying, the persons’ needs may change dynamically and intensive PC is often required. Following the death of a person, bereavement services benefit loved ones. The authors conclude that the inclusion of PC within the regular clinical framework for people with heart failure results in a substantial improvement in quality of life as well as comfort and dignity whilst dying.

Therapeutic Components of Digital Counseling for Chronic Heart Failure (CHF) (Preprint)

2021 ◽  
Author(s):  
Gabriel Camillo Fezza ◽  
Stephanie Sansone ◽  
Robert Nolan
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Kansas City ◽  
Task Force ◽  
Behavioral Therapy ◽  
Assessment Tools ◽  
Self Assessment ◽  
Counseling Interventions ◽  
Related Quality ◽  
Health Related

BACKGROUND Task force statements support the use of cognitive behavioral therapy (CBT) and motivational interviewing (MI) to promote self-care in patients with chronic heart failure (CHF). Digital counseling interventions have the potential to complement conventional programs. However, therapeutic components of digital programs that are associated with improved outcomes are not clearly established. OBJECTIVE Identify therapeutic components of the Canadian e-Platform to Promote Behavioral Self-Management in Chronic Heart Failure (CHF-CePPORT) protocol that were associated with improved health-related quality of life (HRQL). METHODS Ordinal logistic regression was used to identify the therapeutic components of the CHF-CePPORT protocol. The primary outcome was the 12-month Kansas City Cardiomyopathy Questionnaire: Overall Summary (KCCQ-OS) tertile. Logistic regressions determined the association between 12-month KCCQ-OS tertile, using logon hours for key segments of the protocol, modality of content delivery, and clinical themes. RESULTS Patients (n = 117) in this study were enrolled in the e-Counseling arm of the CHF-CePPORT trial. Median age was 60 years (IQR 52-69). Total logon hours in the initial 4-month segment of CHF-CePPORT (Sessions 1-16) was associated with increased 12-month KCCQ-OS tertile (Odds Ratio, OR = 1.31, 95% CI, 1.1-1.5, P = 0.001). Within sessions 1-16, improved KCCQ-OS was associated with logon hours for self-assessment tools/trackers (OR = 1.49, 95% CI, 1.1-2.0, P = 0.007), and videos (OR = 1.57, 95% CI, 1.03-2.4, P = 0.04), but not for CHF information pages. CONCLUSIONS This study highlights the importance of using evidence-based guidelines from CBT and MI as core components of digital counseling, delivered through videos and interactive tools/trackers, to improve HRQL with CHF. CLINICALTRIAL CHF-CePPORT Trial ClinicalTrials.gov NCT01864369

Implementation of a multidisciplinary palliative and supportive care education lecture series.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 144-144
Author(s):  
Shawna Chan ◽  
Solomon Liao ◽  
Leslie M. Randall ◽  
Aaron Kheriaty ◽  
Rakhi Dayal ◽  
...  
Keyword(s):  
Palliative Care ◽  
Medical Students ◽  
Supportive Care ◽  
Physical Symptoms ◽  
Spiritual Needs ◽  
Cultural Considerations ◽  
Lecture Series ◽  
Communication Goals ◽  
Advance Care ◽  
Clinical Departments

144 Background: Nationwide surveys of residents including those in oncologic specialties reveal that trainees perceive their palliative and supportive care (PSC) educational curriculum as inadequate. For residents, PSC education varies from none at all to an organized department lecture series given by Palliative Medicine physicians. There have been no published experiences of institutional wide PSC lecture series open to all residents, fellows, and medical students. Methods: We piloted a monthly palliative care lecture series from August 2016 to June 2017 at UC Irvine. 12 physicians from 9 clinical departments provided monthly lectures on management of physical symptoms, psychosocial issues, cultural considerations, spiritual needs, care coordination, ethical/legal issues, communication/goals of care, and advance care planning. Lectures were advertised in advance to program directors and emails were sent the week prior to all trainees. At the end of each lecture, attendees were given a voluntary survey that consisted of 10 questions on self-perceived competency in PSC skills and 4 questions on attitudes toward PSC. Results: 143 (45 medical students, 98 residents) responses were received. Most residents (90.8%) and medical students (84.4%) viewed palliative care as an important competency. Only 16 responses from heme/onc, radiation, and gynecology oncology residents and fellows were received, comprising 11.2% of total responses. Residents characterized themselves as “not at all/minimally/somewhat confident” in their ability to care for patients with PSC issues in the following areas: management of opioids (44.2%), fatigue (82.7%), anorexia (79.6%), depression (65.3%), and prognostication (75.5%) Medical students characterized themselves as “not at all/minimally/somewhat confident” in the following areas: management of opioids (79.3%), fatigue (86.7%), anorexia (91.1%), depression (71.1%), and prognostication (91.1%). Conclusions: These findings suggest a need to further improve domains of palliative care training in residency programs and identify innovative ways to increase participation of residents and fellows from all oncologic specialties.

Abstract 13221: Family Caregivers’ Perceptions of Illness Severity in Heart Failure Patients with Limited Life Expectancy

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Lisa Kitko ◽  
Judith Hupcey ◽  
Maureen Palese
Keyword(s):  
Heart Failure ◽  
Palliative Care ◽  
Quality Care ◽  
Healthcare Providers ◽  
Illness Severity ◽  
Patient Death ◽  
Disease Trajectory ◽  
Advance Care ◽  
Hospice And Palliative Care ◽  
Perceived Illness

Introduction: End-of-life (EOL) services, such as hospice and palliative care are often lacking even for the sickest heart failure (HF) patients. Use of these services have been hampered by the lack of availability, lack of referrals due to the unpredictable course in HF, and refusal of services by patients and caregivers due to a lack of understanding of the terminality of HF. The purpose of this study was to determine whether caregivers of HF patients with a predicted survival of less than 2 years, understood disease terminality prior to and after the patient’s death. Methods: As part of a longitudinal study of 100 patient-caregiver dyads, caregivers were interviewed monthly until the patient’s death and then twice post-death. Caregiver interviews immediately preceding and post-patient death were analyzed to determine caregivers’ perceptions of the terminality of heart failure. Results: There were 49 caregivers of patients who died. Patients died an average of 8 months after study enrollment. Most caregivers did not understand the severity of the patient’s disease and 51% (25/49) viewed the death as unexpected. When caregivers retrospectively reflected on the patient’s illness trajectory, they recounted downward trends in patient’s health, but were not aware of the terminality of the patient until after death occurred. Those few caregivers who perceived the illness severity prior to death came to this realization late in the disease trajectory. At the point of recognition, advanced treatments were limited or withdrawn and the short-term use of EOL services such as palliative care or hospice was instituted. Conclusions: The lack of perceived illness severity/terminality has profound implications for patients, caregivers, and healthcare providers. Patients and caregivers who do not understand the seriousness of the illness are less likely to accept EOL services, if offered. Clinicians need to understand the HF EOL trajectory and that EOL discussions and advance care planning help patients and caregivers make informed choices and receive quality care at EOL. We also need to educate all healthcare providers about having these discussions, so palliative care becomes a philosophy of care not merely a referral service immediately preceding death.

Palliative Care in Heart Failure

2019 ◽  
pp. 559-570
Author(s):  
J. Nicholas Dionne-Odom ◽  
Rachel Wells ◽  
Keith M. Swetz
Keyword(s):  
Heart Failure ◽  
Palliative Care ◽  
Symptom Management ◽  
Clinical Manifestations ◽  
Advanced Heart Failure ◽  
Care Planning ◽  
Care Nurse ◽  
Practice Nurses ◽  
Advance Care ◽  
Underlying Pathophysiology

Specialty palliative care in advanced heart failure is an emerging area of clinical practice. Nurses play a key role in providing in- and outpatient palliative care for these patients and their families. This chapter provides an overview of advanced heart failure for the palliative care nurse at all levels of practice. Topics discuss underlying pathophysiology and causes of advanced heart failure, clinical manifestations and staging, assessment and diagnostic findings, pharmacologic and nonpharmacologic management, heart failure devices, symptom management, and advance care planning. Many of these topics are summarized in brief, and hence clinicians are encouraged to refer to cited sources for more in-depth discussion that may be appropriate for individual settings and patient populations.

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