Doctors' perceptions of palliative care for heart failure: focus group study

Background: Aggravated by the COVID-19 pandemic, the provision of palliative care for patients with palliative care needs emerges as a necessity more than ever. Most are managed in primary care by their family physicians (FP). This study aimed to understand the perspectives of specialist and trainee FPs about their role in palliative care. Methods: we conducted a double focus-group study consisting of two separate online focus-groups, one with FP specialists (n = 9) and one with FP trainees (n = 10). Results: FPs already gather two fundamental skills for the provision of palliative care: the capacity to identify patients’ needs beyond physical symptoms and the recognition that the patient belongs to a familiar, psychosocial, and even spiritual environment. They perceive their role in palliative care to be four-fold: early identification of patients with palliative care needs, initial treatment, symptom management, and patient advocacy. Participants recognized the need for palliative care training and provided suggestions for training programs. Conclusion: FPs share a holistic approach and identify multiple roles they can play in palliative care, from screening to care and advocacy. Organizational barriers must be addressed. Short training programs that combine theory, practice, and experiential learning may further the potential for FPs to contribute to palliative care.

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Physicians’ Views on the Usefulness and Feasibility of Identifying and Disclosing Patients’ Last Phase of Life and their Experiences with Using the Surprise Question: A Focus Group Study

10.21203/rs.3.rs-57948/v1 ◽

2020 ◽

Author(s):

Catherine Owusuaa ◽

Irene van Beelen ◽

Agnes van der Heide ◽

Carin C.D. van der Rijt

Keyword(s):

Palliative Care ◽

Focus Group ◽

Focus Groups ◽

Advanced Cancer ◽

Care Quality ◽

Chronic Obstructive ◽

Focus Group Study ◽

Timely Initiation ◽

Imminent Death ◽

Surprise Question

Abstract Background: Accurate assessment that a patient is in the last phase of life is a prerequisite for timely initiation of palliative care in patients with a life-limiting disease, such as advanced cancer or advanced organ failure. Several palliative care quality standards recommend the surprise question to identify those patients.Methods: Physicians’ views of identifying and disclosing the last phase of life and their experiences with using the surprise question for patients with advanced cancer or chronic obstructive pulmonary disease (COPD) were explored in a qualitative focus group study. Data were analyzed using thematic analysis.Results: Fifteen medical specialists and general practitioners participated in two focus groups. Themes discussed in the focus groups were: prediction and disclosure of the imminence of death. Participants thought prediction of imminent death, within one year, was important. The surprise question was considered a useful prognostic tool; its use is facilitated by its simplicity but hampered by its subjective character. The medical specialist was considered mainly responsible for prognosticating and gradual disclosing a patient’s imminent death. Physicians’ reluctance to disclose the imminence of death to a patient was related to the uncertainty around prognostication, concerns about depriving patients of hope or affecting the physician–patient relationship, or about a lack of time or of palliative care services. Conclusions: Physicians consider the assessment of patients’ imminent death important and support the use of the surprise question. However, they experience uncertainty and other barriers in disclosing imminent death. Future studies should examine patients’ preferences for those discussions. Trial registration: not applicable.

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Exploring the psychological impact of life‐limiting illness using the Attitude to Health Change scales: A qualitative focus group study in a hospice palliative care setting

European Journal of Cancer Care ◽

10.1111/ecc.13302 ◽

2020 ◽

Vol 29 (6) ◽

Author(s):

Lesley Dunleavy ◽

Catherine Walshe ◽

Linda Machin

Keyword(s):

Palliative Care ◽

Focus Group ◽

Care Setting ◽

Psychological Impact ◽

Attitude To Health ◽

Focus Group Study ◽

Palliative Care Setting ◽

Hospice Palliative Care

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Overcoming barriers to engagement and adherence to a home-based physical activity intervention for patients with heart failure: a qualitative focus group study

BMJ Open ◽

10.1136/bmjopen-2019-036382 ◽

2020 ◽

Vol 10 (9) ◽

pp. e036382

Author(s):

Nduka C Okwose ◽

Nicola O'Brien ◽

Sarah Charman ◽

Sophie Cassidy ◽

David Brodie ◽

...

Keyword(s):

Physical Activity ◽

Heart Failure ◽

Focus Group ◽

Family Members ◽

Barriers And Facilitators ◽

Behavioural Intervention ◽

Focus Group Study ◽

Home Based ◽

Patients With Heart Failure

ObjectivesClinical guidelines recommend regular physical activity for patients with heart failure to improve functional capacity and symptoms and to reduce hospitalisation. Cardiac rehabilitation programmes have demonstrated success in this regard; however, uptake and adherence are suboptimal. Home-based physical activity programmes have gained popularity to address these issues, although it is acknowledged that their ability to provide personalised support will impact on their effectiveness. This study aimed to identify barriers and facilitators to engagement and adherence to a home-based physical activity programme, and to identify ways in which it could be integrated into the care pathway for patients with heart failure.DesignA qualitative focus group study was conducted. Data were analysed using thematic analysis.ParticipantsA purposive sample of 16 patients, 82% male, aged 68±7 years, with heart failure duration of 10±9 years were recruited.InterventionA 12-week behavioural intervention targeting physical activity was delivered once per week by telephone.ResultsTen main themes were generated that provided a comprehensive overview of the active ingredients of the intervention in terms of engagement and adherence. Fear of undertaking physical activity was reported to be a significant barrier to engagement. Influences of family members were both barriers and facilitators to engagement and adherence. Facilitators included endorsement of the intervention by clinicians knowledgeable about physical activity in the context of heart failure; ongoing support and personalised feedback from team members, including tailoring to meet individual needs, overcome barriers and increase confidence.ConclusionsEndorsement of interventions by clinicians to reduce patients’ fear of undertaking physical activity and individual tailoring to overcome barriers are necessary for long-term adherence. Encouraging family members to attend consultations to address misconceptions and fear about the contraindications of physical activity in the context of heart failure should be considered for adherence, and peer-support for long-term maintenance.Trial registration numberNCT03677271.

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