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BMC Health Services Research
Published in: BMC Health Services Research 1/2016

Open Access 01-12-2016 | Research article

Palliative care for patients with heart failure: facilitators and barriers - a cross sectional survey of German health care professionals

Authors: Jeanette Ziehm, Erik Farin, Jonas Schäfer, Kathrin Woitha, Gerhild Becker, Stefan Köberich

Published in: BMC Health Services Research | Issue 1/2016

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Abstract

Background

Compared to patients with cancer, heart failure patients are seldom candidates for palliative care. Numerous studies have investigated reasons why heart failure patients do not receive palliative care; however, none of these studies have ever evaluated the situation in the German health care setting. This study aims to identify German healthcare providers’ (HCP) perception of barriers and facilitators to palliative care of patients with chronic heart failure.

Methods

We conducted an online-survey with 315 nurses and physicians of different medical disciplines.

Results

Even though heart failure patients’ need of palliative care and its advantages has been recognized, HCP see potential for development and improvement. A lack of knowledge about the content and measures of palliative care, poor communication and unclear responsibilities between medical disciplines, difficulties to determine the right time to initiate palliative care, and the feeling not to be prepared to discuss end-of-life issues with the patient has been identified as barriers. Further, HCP believe that patients and relatives do not possess adequate knowledge about the disease and its progression and are therefore unprepared in asking questions regarding palliative care. They rather tend to demand everything possible to be done in order prolong life, and are reluctant to accept that life is limited. Overall, HCP perceive that dying is a taboo subject within our society placing palliative care on the same level as assisted dying. In addition, results indicate that HCP have an inappropriate notion of ideal medicine fearing to lose patient and are worried about the appropriateness of PC remuneration.

Conclusions

In order to overcome the described barriers, HCP, patients, and relatives need to be educated in palliative care. Information and education encompassing the aim, content and measures of palliative care needs to be provided for all parties in order to optimize patient care, to foster communication between healthcare professionals, patients, and relatives, and to overcome perceived barriers.

Trial registration

Appendix
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Literature
1.
Ohlmeier C, Mikolajczyk R, Frick J, Prutz F, Haverkamp W, Garbe E. Incidence, prevalence and 1-year all-cause mortality of heart failure in Germany: a study based on electronic healthcare data of more than six million persons. Clin Res Cardiol. 2015;104(8):688–96.CrossRefPubMed
2.
3.
Ekman I, Granger B, Swedberg K, Stenlund H, Boman K. Measuring shortness of breath in heart failure (SOB-HF): development and validation of a new dyspnoea assessment tool. Eur J Heart Fail. 2011;13(8):838–45.CrossRefPubMed
4.
Barnes S, Gott M, Payne S, Parker C, Seamark D, Gariballa S, et al. Prevalence of symptoms in a community-based sample of heart failure patients. J Pain Symptom Manage. 2006;32(3):208–16.CrossRefPubMed
5.
6.
Conley S, Feder S, Redeker NS. The relationship between pain, fatigue, depression and functional performance in stable heart failure. Heart Lung. 2015;44(2):107–12.CrossRefPubMedPubMedCentral
7.
Corsonello A, Pedone C, Carosella L, Corica F, Mazzei B, Incalzi RA, et al. Health status in older hospitalized patients with cancer or non-neoplastic chronic diseases. BMC Geriatr. 2005;5:10.CrossRefPubMedPubMedCentral
8.
Incalzi RA, Corsonello A, Pedone C, Corica F, Carbonin P, Bernabei R, et al. Construct validity of activities of daily living scale: a clue to distinguish the disabling effects of COPD and congestive heart failure. Chest. 2005;127(3):830–8.CrossRefPubMed
9.
Janssen DJ, Franssen FM, Wouters EF, Schols JM, Spruit MA. Impaired health status and care dependency in patients with advanced COPD or chronic heart failure. Qual Life Res Int J Qual Life Asp Treat Care Rehab. 2011;20(10):1679–88.CrossRef
10.
Köberich S, Lohrmann C, Dassen T. Care dependency in patients with chronic obstructive pulmonary disease and heart failure - a secondary data analysis of German prevalence studies. Scand J Caring Sci. 2014;28(4):665–74.CrossRefPubMed
11.
Imes CC, Dougherty CM, Pyper G, Sullivan MD. Descriptive study of partners’ experiences of living with severe heart failure. Heart Lung. 2011;40(3):208–16.CrossRefPubMedPubMedCentral
12.
Pressler SJ, Gradus-Pizlo I, Chubinski SD, Smith G, Wheeler S, Sloan R, et al. Family caregivers of patients with heart failure: a longitudinal study. J Cardiovasc Nurs. 2013;28(5):417–28.CrossRefPubMed
13.
Brostrom A, Stromberg A, Dahlstrom U, Fridlund B. Congestive heart failure, spouses’ support and the couple’s sleep situation: a critical incident technique analysis. J Clin Nurs. 2003;12(2):223–33. 34.CrossRefPubMed
14.
Luttik ML, Lesman-Leegte I, Jaarsma T. Quality of life and depressive symptoms in heart failure patients and their partners: the impact of role and gender. J Card Fail. 2009;15(7):580–5.CrossRefPubMed
15.
Martensson J, Dracup K, Canary C, Fridlund B. Living with heart failure: depression and quality of life in patients and spouses. J Heart Lung Transplant. 2003;22(4):460–7.CrossRefPubMed
16.
Pihl E, Jacobsson A, Fridlund B, Stromberg A, Martensson J. Depression and health-related quality of life in elderly patients suffering from heart failure and their spouses: a comparative study. Eur J Heart Fail. 2005;7(4):583–9.CrossRefPubMed
17.
Bekelman DB, Rumsfeld JS, Havranek EP, Yamashita TE, Hutt E, Gottlieb SH, et al. Symptom burden, depression, and spiritual well-being: a comparison of heart failure and advanced cancer patients. J Gen Intern Med. 2009;24(5):592–8.CrossRefPubMedPubMedCentral
18.
O’Leary N, Murphy NF, O’Loughlin C, Tiernan E, McDonald K. A comparative study of the palliative care needs of heart failure and cancer patients. Eur J Heart Fail. 2009;11(4):406–12.CrossRefPubMed
19.
Pantilat SZ, O’Riordan DL, Dibble SL, Landefeld CS. Longitudinal assessment of symptom severity among hospitalized elders diagnosed with cancer, heart failure, and chronic obstructive pulmonary disease. J Hosp Med. 2012;7(7):567–72.CrossRefPubMed
20.
Goodlin SJ, Kutner JS, Connor SR, Ryndes T, Houser J, Hauptman PJ. Hospice care for heart failure patients. J Pain Symptom Manage. 2005;29(5):525–8.CrossRefPubMed
21.
22.
Pantilat SZ, Steimle AE. Palliative care for patients with heart failure. JAMA. 2004;291(20):2476–82.CrossRefPubMed
23.
24.
Schwarz ER, Baraghoush A, Morrissey RP, Shah AB, Shinde AM, Phan A, et al. Pilot study of palliative care consultation in patients with advanced heart failure referred for cardiac transplantation. J Palliat Med. 2012;15(1):12–5.CrossRefPubMed
25.
Brannstrom M, Boman K. Effects of person-centred and integrated chronic heart failure and palliative home care. PREFER: a randomized controlled study. Eur J Heart Fail. 2014;16(10):1142–51.CrossRefPubMed
26.
Evangelista LS, Liao S, Motie M, De Michelis N, Lombardo D. On-going palliative care enhances perceived control and patient activation and reduces symptom distress in patients with symptomatic heart failure: a pilot study. Eur J Cardiovasc Nurs. 2014;13(2):116–23.CrossRefPubMedPubMedCentral
27.
Evangelista LS, Lombardo D, Malik S, Ballard-Hernandez J, Motie M, Liao S. Examining the effects of an outpatient palliative care consultation on symptom burden, depression, and quality of life in patients with symptomatic heart failure. J Card Fail. 2012;18(12):894–9.CrossRefPubMedPubMedCentral
28.
Wong RC, Tan PT, Seow YH, Aziz S, Oo N, Seow SC, et al. Home-based advance care programme is effective in reducing hospitalisations of advanced heart failure patients: a clinical and healthcare cost study. Ann Acad Med Singapore. 2013;42(9):466–71.PubMed
29.
Sidebottom AC, Jorgenson A, Richards H, Kirven J, Sillah A. Inpatient palliative care for patients with acute heart failure: outcomes from a randomized trial. J Palliat Med. 2015;18(2):134–42.CrossRefPubMed
30.
Beernaert K, Deliens L, De Vleminck A, Devroey D, Pardon K, Van den Block L, et al. Early identification of palliative care needs by family physicians: a qualitative study of barriers and facilitators from the perspective of family physicians, community nurses, and patients. Palliat Med. 2014;28(6):480–90.CrossRefPubMed
31.
Hanratty B, Hibbert D, Mair F, May C, Ward C, Capewell S, et al. Doctors' perceptions of palliative care for heart failure: focus group study. BMJ. 2002;325(7364):581–5.CrossRefPubMedPubMedCentral
32.
33.
Kavalieratos D, Mitchell EM, Carey TS, Dev S, Biddle AK, Reeve BB, et al. “Not the ‘grim reaper service”: an assessment of provider knowledge, attitudes, and perceptions regarding palliative care referral barriers in heart failure. J Am Heart Assoc. 2014;3(1):e000544.CrossRefPubMedPubMedCentral
34.
Browne S, Macdonald S, May CR, Macleod U, Mair FS. Patient, carer and professional perspectives on barriers and facilitators to quality care in advanced heart failure. PLoS One. 2014;9(3), e93288.CrossRefPubMedPubMedCentral
35.
36.
37.
Ziehm J, Farin-Glattacker E, Seibel K, Becker G, Köberich S. Healthcare Professionals' Attitudes Regarding Palliative Care for Patients with Chronic Heart Failure: An Interview Study BMC Palliative Care. submitted.
38.
Mayring P. Qualitative Inhaltsanalyse: Grundlagen und Techniken. Beltz Verlag: Weinheim und Basel; 2010.CrossRef
39.
40.
Dracup K, Moser DK, Pelter MM, Nesbitt T, Southard J, Paul SM, et al. Rural patients’ knowledge about heart failure. J Cardiovasc Nurs. 2014;29(5):423–8.CrossRefPubMedPubMedCentral
41.
Rodriguez KL, Appelt CJ, Switzer GE, Sonel AF, Arnold RM. “They diagnosed bad heart”: a qualitative exploration of patients’ knowledge about and experiences with heart failure. Heart Lung. 2008;37(4):257–65.CrossRefPubMed
42.
Klindtworth K, Oster P, Hager K, Krause O, Bleidorn J, Schneider N. Living with and dying from advanced heart failure: understanding the needs of older patients at the end of life. BMC Geriatr. 2015;15:125.CrossRefPubMedPubMedCentral
43.
Boyde M, Song S, Peters R, Turner C, Thompson DR, Stewart S. Pilot testing of a self-care education intervention for patients with heart failure. Eur J Cardiovasc Nurs. 2013;12(1):39–46.CrossRefPubMed
44.
Roncalli J, Perez L, Pathak A, Spinazze L, Mazon S, Lairez O, et al. Improvement of young and elderly patient’s knowledge of heart failure after an educational session. Clin Med Cardiology. 2009;3:45–52.PubMed
45.
Swetz KM, Shanafelt TD, Drozdowicz LB, Sloan JA, Novotny PJ, Durst LA, et al. Symptom burden, quality of life, and attitudes toward palliative care in patients with pulmonary arterial hypertension: results from a cross-sectional patient survey. J Heart Lung Transplant. 2012;31(10):1102–8.CrossRefPubMed
46.
Momeyer R. Does physician assisted suicide violate the integrity of medicine? J Med Philos. 1995;20(1):13–24.CrossRefPubMed
47.
MacLeod RD, Thompson R, Fisher JW, Mayo K, Newman NW, Wilson DM. New Zealanders’ knowledge of palliative care and hospice services. N Z Med J. 2012;125(1348):51–60.PubMed
48.
McIlfatrick S, Noble H, McCorry NK, Roulston A, Hasson F, McLaughlin D, et al. Exploring public awareness and perceptions of palliative care: a qualitative study. Palliat Med. 2014;28(3):273–80.CrossRefPubMed
49.
Gelfman LP, Kalman J, Goldstein NE. Engaging heart failure clinicians to increase palliative care referrals: overcoming barriers, improving techniques. J Palliat Med. 2014;17(7):753–60.CrossRefPubMedPubMedCentral
50.
Strachan PH, Joy C, Costigan J, Carter N. Development of a practice tool for community-based nurses: the Heart Failure Palliative Approach to Care (HeFPAC). Eur J Cardiovasc Nurs. 2014;13(2):134–41.CrossRefPubMed
51.
Thoonsen B, Engels Y, van Rijswijk E, Verhagen S, van Weel C, Groot M, et al. Early identification of palliative care patients in general practice: development of RADboud indicators for PAlliative Care Needs (RADPAC). Br J Gen Pract. 2012;62(602):e625–31.CrossRefPubMedPubMedCentral
52.
Moroni M, Zocchi D, Bolognesi D, Abernethy A, Rondelli R, Savorani G, et al. The ‘surprise’ question in advanced cancer patients: A prospective study among general practitioners. Palliat Med. 2014;28(7):959–64.CrossRefPubMed
53.
Murray S, Boyd K. Using the ‘surprise question’ can identify people with advanced heart failure and COPD who would benefit from a palliative care approach. Palliat Med. 2011;25(4):382.CrossRefPubMed
54.
Small N, Gardiner C, Barnes S, Gott M, Payne S, Seamark D, et al. Using a prediction of death in the next 12 months as a prompt for referral to palliative care acts to the detriment of patients with heart failure and chronic obstructive pulmonary disease. Palliat Med. 2010;24(7):740–1.CrossRefPubMed
55.
Afshar K, Geiger K, Muller-Mundt G, Bleidorn J, Schneider N. [Generalist palliative care for non-cancer patients : a review article]. Schmerz (Berlin, Germany). 2015;29(6):604–15.CrossRef
56.
Johnson MJ, Maccallum A, Butler J, Rogers A, Sam E, Fuller A, et al. Heart failure specialist nurses’ use of palliative care services: a comparison of surveys across England in 2005 and 2010. Eur J Cardiovasc Nurs. 2012;11(2):190–6.CrossRefPubMed
57.
Kirolos I, Tamariz L, Schultz EA, Diaz Y, Wood BA, Palacio A. Interventions to improve hospice and palliative care referral: a systematic review. J Palliat Med. 2014;17(8):957–64.CrossRefPubMed
58.
Davidson PM, Paull G, Introna K, Cockburn J, Davis JM, Rees D, et al. Integrated, collaborative palliative care in heart failure: the St. George heart failure service experience 1999-2002. J Cardiovasc Nurs. 2004;19(1):68–75.CrossRefPubMed
59.
Lindvall C, Hultman TD, Jackson VA. Overcoming the barriers to palliative care referral for patients with advanced heart failure. J Am Heart Assoc. 2014;3(1), e000742.CrossRefPubMedPubMedCentral
60.
Metadata
Title
Palliative care for patients with heart failure: facilitators and barriers - a cross sectional survey of German health care professionals
Authors
Jeanette Ziehm
Erik Farin
Jonas Schäfer
Kathrin Woitha
Gerhild Becker
Stefan Köberich
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2016
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-016-1609-x

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