Palliative Care for Patients with Heart Failure in the Outpatient Setting: An Integrative Review (GP721)

Abstract

•Describe the importance of integrating palliative care alongside curative therapies.•Describe the current state of outpatient palliative care research. Early integration of palliative care into the care of patients with heart failure improves quality of life and decreases unnecessary healthcare utilization. Palliative care is beginning to expand into the outpatient setting for patients with heart failure. However, there is limited knowledge regarding the state of palliative care for patients with heart failure in the outpatient setting. To synthesize the literature of outpatient palliative care in patients with heart failure within the framework of the eight domains of palliative care. A systematic search of PubMed, Embase, CINAHL, Cochrane, and Web of Science was conducted from inception to February 2019 for studies of palliative care in outpatient settings in adults with heart failure. Study characteristics, location of palliative care, components of the intervention or service, participant characteristics, domains of palliative care and main findings were extracted. Of the nineteen studies, the majority employed a quantitative design and were conducted in the United States. Palliative care delivery mainly occurred in the home or palliative care clinic; providers were mainly palliative care specialists. Palliative care services or interventions focused on physical symptom assessment and management. The structural, physical, and psychological domains were most commonly addressed. The least commonly addressed domains were the cultural and ethical/legal domains. No study addressed every domain of palliative care. Women and ethnic minorities were underrepresented in the majority of samples. Outpatient palliative care improves QOL and decreases re-hospitalizations. Despite extremely limited access to specialty palliative care, primary palliative care was rarely utilized. There was a lack of ethnic and clinical diversity among study participants, resulting in a lack of knowledge of unique considerations for these populations. Finally, limited emphasis on the ethical, legal, and cultural domains of palliative care highlights opportunities for future research.