Abstract
BackgroundEven though struggling with similar symptom burden, patients with chronic heart failure (CHF) receive less palliative care than patients suffering from malignant diseases. Researchers have found that this might be related to lack of knowledge about palliative care, insufficient interprofessional communication as well as the cyclic course of disease which makes accurate prognosis difficult. However, research findings have shown that patients with CHF benefit from palliative care. As there are no studies for the German health care system this study aimed to assess health care professionals’ attitudes regarding palliative care of CHF patients in order to identify barriers and facilitators for this patient group and hence to develop recommendations for improvement of CHF patients’ access to palliative care in Germany.MethodProblem-centered interviews with 23 health care professionals involved in care of CHF patients (nurses: hospital, outpatient, heart failure, PC; physicians: hospital and resident cardiologists, general practitioners) were conducted and analysed according to Mayring’s qualitative content analysis.ResultsMost interviewees perceived a need for palliative care for CHF patients. Regarding barriers patients’, public’s, and professionals’ lack of knowledge of palliative care and CHF; shortcomings in communication and cooperation of different professional groups; inability of cardiology to accept medical limits; difficult prognosis of course of disease; and patients’ concerns regarding palliative care were described. Different attitudes regarding appropriate time of initiation of palliative care for CHF patients (late vs. early) were found. Furthermore, better communication and closer cooperation between different professional groups and medical disciplines as well as better education about palliative care and CHF for professionals, patients, and public were cited.ConclusionsPalliative care for CHF patients is a neglected topic in both practice and research and should receive more attention. Barriers to palliative care for CHF patients might be overcome by: better education for the public, patients, and professionals, closer cooperation between the different professional groups involved as well as development of a joint agreement regarding the appropriate time to administer palliative care to CHF patients.Trial registrationDRKS00007119.Electronic supplementary materialThe online version of this article (doi:10.1186/s12904-016-0149-9) contains supplementary material, which is available to authorized users.
Highlights
Even though struggling with similar symptom burden, patients with chronic heart failure (CHF) receive less palliative care than patients suffering from malignant diseases
Most interviewees perceived a need for palliative care for CHF patients
Even though symptom burden of CHF patients is as high as in patients with malignant diseases, data suggest that palliative care for CHF patients and patients with malignant diseases differs qualitatively as well as quantitatively [11, 12]
Summary
Even though struggling with similar symptom burden, patients with chronic heart failure (CHF) receive less palliative care than patients suffering from malignant diseases. Physicians’ and nurses’ perceived barriers to refer CHF patients to palliative care are based on the experience of poor interprofessional communication and collaboration [13, 15, 18] and divergent philosophies of different health care providers (cardiologist vs general practitioner, nurses vs physicians) [15, 17, 18], poor knowledge [13] about and insufficient skills to perform palliative care by general practitioners and cardiologists [13,14,15, 17], and difficulties identifying the appropriate time to refer CHF patients to palliative care [15, 16]. As patients did not articulate non-acute palliative care needs to their general practitioner early identification of those needs barely happened [13]
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