Describing evaluations and treatment recommendations performed during outpatient palliative care consultations for individuals with advanced heart failure

Abstract

Background Little has been reported about what happens during an outpatient palliative care consultation (OPCC) for persons with advanced heart failure (HF). Methods Qualitative content analysis of provider notes documented during OPCCs of NYHA Class III/IV patients performed per protocol as part of a parent pilot trial of an early concurrent HF palliative care intervention (ENABLE CHF-PC: Educate, Nurture, Advise, Before Life Ends; [4/1/14–8/31/15]) conducted at two sites located in the North- and Southeast. T-tests used to evaluate site-differences. Conclusion OPCCs for HF primarily focused on evaluating symptoms (i.e., mood, dyspnea), advance directive/code status, caregiver/family support, functional status, and on recommending care coordination and referrals. There were considerable regional differences in OPCC assessment and recommendation practices. Results may be biased by disparate OPCC documentation templates at each site. Additional measures, such as uniform charting templates, are needed to ensure that OPCCs for HF patients are comprehensive and standardized. Result Of 61 ENABLE CHF-PC participants, 39 (64%) had an OPCC (Northeast site, n=27; Southeast site, n=12), averaging 60 minutes in duration. Areas most frequently assessed were history of close relationships (n=35, 90%), advance directive/code status (n=33, 85%), family support (n=33, 85%), and functional status (n=30, 77%). Symptoms most frequently evaluated were mood (n= 35, 90%), breathlessness (n=28, 72%), and chest pain (n=24, 62%). Treatment recommendations focused on care coordination (n=13, 33%) and specialty referrals (n=12, 31%). Between-site OPCC differences included assessment of family support (Northeast vs. Southeast site: 100% vs. 50%), code status (96% vs. 58%), goals of care discussions (89% vs. 41.7%), and prognosis understanding (85% vs. 33%). Treatment recommendation differences were most pronounced for care coordination (40.7% vs. 17%).