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Should heart failure be regarded as a terminal illness requiring palliative care? A study of heart failure patients’, carers’ and clinicians’ understanding of heart failure prognosis and its management
  1. Rachel Stocker,
  2. Helen Close,
  3. Helen Hancock and
  4. A Pali S Hungin
  1. School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK
  1. Correspondence to Dr Rachel Stocker, Newcastle University, Institute of Health and Society, Campus for Ageing and Vitality, Newcastle-upon-Tyne, NE4 5PL; rachel.stocker{at}newcastle.ac.uk

Abstract

Objectives Communication and planning for heart failure (HF) care near the end of life is known to be complex. Little is known about how the patient experience of palliative assessment and communication needs change over time, and how this might inform management. Our aim was to explore experiences of giving or receiving a prognosis and advanced palliative care planning (ACP) for those with HF.

Methods We carried out a longitudinal grounded theory study, employing in-depth interviews with 14 clinicians (primary and secondary care) and observations of clinic and home appointments, followed by a series of interviews with 13 patients with HF and 9 carers.

Results Overall, the majority of participants rejected notions of HF as a terminal illness in favour of a focus on day-to-day management and maintenance, despite obvious deterioration in disease stage and needs over time. Clinicians revealed frustration about the uncertain nature of HF prognosis, leading to difficulties in planning. Others highlighted the need to deliver problem-based, individualised care but felt constrained sometimes by the lack of multidisciplinary ACP. Patients reported an absence of prognostic discussions with clinicians.

Conclusions This is the first study exploring the experiences of prognostic communication at all stages of HF. Findings raise questions regarding the pragmatic utility of the concept of HF as a terminal illness and have implications for future HF care pathway development. Findings support the incorporation of a problem-based approach to management, which recognises the importance of everyday functioning for patients and carers as well as the opportunity for ACP.

  • Prognosis
  • Heart failure
  • Chronic conditions
  • Communication
  • End of life care < Ethics
  • Terminal care
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Footnotes

  • Contributors Planning, study concept and design: RS, HC and APSH. Data collection: RS. Data analysis, reviewing and finalising paper: RS, HC, HH and APSH. Guarantor: RS.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Durham University and the local NHS Research Ethics Committee (ref: 11/NE/0313).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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