Evaluation of the effectiveness of the physician education program on primary palliative care in heart failure.

Tatsuhiro Shibata,Yoshihiro Fukumoto,Takuya Kishi,Tomonao Okamura,Tatsuyuki Kakuma,Shogo Oishi,Takashi Ohmori,Atsushi Mizuno,Akihiro Sakashita,Hideyuki Kashiwagi,Hitoshi Obara,Alexander H Maass

doi:10.1371/journal.pone.0263523

Abstract

Major cardiology societies' guidelines support integrating palliative care into heart failure (HF) care. This study aimed to identify the effectiveness of the HEart failure Palliative care Training program for comprehensive care providers (HEPT), a physician education program on primary palliative care in HF. We performed a pre- and post-test survey to evaluate HEPT outcomes. Physician-reported practices, difficulties and knowledge were evaluated using the Palliative Care Self-Reported Practices Scale in HF (PCPS-HF), Palliative Care Difficulties Scale in HF (PCDS-HF), and Palliative care knowledge Test in HF (PT-HF), respectively. Structural equation models (SEM) were used to estimate path coefficients for PCPS-HF, PCDS-HF, and PT-HF. A total of 207 physicians participated in the HEPT between February 2018 and July 2019, and 148 questionnaires were ultimately analyzed. The total PCPS-HF, PCDS-HF, and PT-HF scores were significantly improved 6 months after HEPT completion (61.1 vs 67.7, p<0.001, 54.9 vs 45.1, p<0.001, and 20.8 vs 25.7, p<0.001, respectively). SEM analysis showed that for pre-post difference (Dif) PCPS-HF, "clinical experience of more than 14 years" and pre-test score had significant negative effects (-2.31, p = 0.048, 0.52, p<0.001, respectively). For Dif PCDS-HF, ≥ "28 years old or older" had a significant positive direct effect (13.63, p<0.001), although the pre-test score had a negative direct effect (-0.56, p<0.001). For PT-HF, "involvement in more than 50 HF patients' treatment in the past year" showed a positive direct effect (0.72, p = 0.046), although the pre-test score showed a negative effect (-0.78, p<0.001). Physicians who completed the HEPT showed significant improvements in practice, difficulty, and knowledge scales in HF palliative care.

Highlights

During the present decade, the increase in patients with heart failure (HF) has become an important healthcare issue worldwide
Most evidence of palliative care comes from oncology, several recent reports have suggested that palliative care interventions for HF patients can improve symptom burden and quality of life (QOL) [2,3,4,5]
The present study indicated that measures of physician-reported practice, difficulty, and knowledge scales in HF palliative care significantly improved six months after completion of the HEPT, an education program focused on primary palliative care for HF

Summary

Introduction

The increase in patients with heart failure (HF) has become an important healthcare issue worldwide. Most evidence of palliative care comes from oncology, several recent reports have suggested that palliative care interventions for HF patients can improve symptom burden and QOL [2,3,4,5] These trends have led to major HF guidelines supporting the integration of palliative care into HF care [6, 7]. There are disease-specific challenges, such as the illness trajectory and disease management in HF, which are different from cancer, including implantable cardioverter defibrillators (ICD) and mechanical circulatory support (MCS) at the end of life [13] Despite this program’s success, there has been no primary palliative care training program tailored to HF clinicians worldwide

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