March 2014
J Am Heart Assoc. 2014 Jan 2;3(1):e000544. doi: 10.1161/JAHA.113.000544.
Kavalieratos D, Mitchell EM, Carey TS, Dev S, Biddle AK, Reeve BB, Abernethy AP, Weinberger M
To investigate barriers to palliative care referral for heart failure patients, semi-structured interviews were carried out either in person or by telephone with 18 physician, nurse practitioner, and non-physician providers from North Carolina, USA. There were six each from cardiology, primary care, and palliative care. The interview focused on symptom burden and prognosis of patients with heart failure. In these interviews there were 10 questions in 4 domains covering the needs of patients with advanced heart failure; views on specialist palliative care; indications and timing of palliative care referral; and barriers to palliative care referral. Two investigators analysed data using template analysis, which combines content analysis and grounded theory. Non-palliative care providers had limited knowledge regarding what palliative care is, and how it can complement traditional heart failure therapy to decrease suffering. Barriers identified included the unpredictable course of heart failure; lack of clear referral triggers; and ambiguity regarding what differentiates standard therapy from palliative care. Nevertheless, providers expressed interest for integrating palliative care into traditional heart failure care, but were unsure of how to initiate collaboration. These finding call for increased education and collaboration between palliative care and other services providing care to patients with advanced heart failure.
Jason Boland