Abstract
The number of end-of-life situations encountered in cardiology is rising. We investigated perceptions and attitudes of medical and paramedical staff regarding end-of-life situations in a qualitative study. Single-centre, qualitative study using semi-directive interviews with physicians, nurses and nurses’ aides in a university hospital cardiology unit. Participants were invited to describe experiences and feelings about end-of-life situations. Verbatim was analysed using thematic analysis. 13 physicians, 16 nurses and 5 nurses’ aides were interviewed. Main themes were: frequency, type of death, value of patient's life, communication, advance directives (AD), consideration of patient's wishes. The majority felt that the end-of-life situations are increasingly frequent, but their management has improved. Cardiology was felt to be a discipline where death is generally rapid; otherwise, for patients with end-stage heart failure, the course of disease allows time to anticipate end of life. The perceived value of the patient's life plays a role in the level of therapeutic engagement. Communication was felt to be key to ensuring that patient, family and healthcare workers (HCW) are all in agreement regarding clinical status and likely outcome. Poor communication was felt to engender suffering both among HCW and families; lack of time was cited as a frequent cause. AD were not unanimously considered useful; some felt that discussing end-of-life may be more harmful than helpful. AD remain infrequent in our unit. The patient's wishes are taken into account if possible, but some believe the patient is not qualified to know what can be done, and in such cases, their wishes may be disregarded as inappropriate to the clinical situation. Most felt that end-of-life is managed better in terms of pain relief and communication. Poor communication remains prevalent and can be a source of suffering. Improving these points should improve overall quality of care.
Highlights
Professional societies call for integration of end-of-life discussions early in the trajectory of heart failure, yet it remains unclear where current practices stand in relation to these recommendations
Several physicians emphasized that Cardiology does not allow the physician to time to ponder at leisure about end-of-life issues, but rather, calls for immediate action to prevent the patient from dying
This study reveals several interesting findings regarding the perceptions that physicians and nurses have about end-of-life issues in a large, university hospital cardiology department
Summary
Professional societies call for integration of end-of-life discussions early in the trajectory of heart failure, yet it remains unclear where current practices stand in relation to these recommendations. Heart failure (HF) is a chronic, progressive disease that counts among the main causes of morbidity and mortality worldwide, affecting approximately 1–2% of the adult population in developed countries, and up to 10% of among those over 70 years of age [1]. Data from the EURObservational Research Programme reported mortality at 1 year of 17.4% in acute HF patients, and 7.2% in chronic stable HF [2]. The guidelines issued by the European Society of Cardiology for the management of acute and chronic HF state that palliative care should be introduced early in the disease trajectory, and intensified as the disease progresses [1, 3]. It has been shown that palliative care yields statistically and clinically significant improvements in patient’s quality of life, and is associated with lower utilization of healthcare resources [7]
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