Though recommended by the American Heart Association, it appears that the subject of death is still not a common topic of discussion with only 12 percent of healthcare providers reporting having routine annual conversations about end-of-life care with their heart failure patients.
Findings from a survey completed by close to 100 physicians, nurse practitioners and physician assistants at practices at the Mayo Clinic Health System and the Mayo Clinic in Rochester, Minnesota, show that nearly one third of healthcare providers feel unconfident and uncomfortable about broaching the subject with their patients and their families. Lack of time was also cited as a reason for avoiding the discussion.
The study was presented at the Quality of Care and Outcomes Research 2014 Scientific Sessions and highlights the fact that there is widespread confusion about who was responsible for bringing up the subject of end-of-life care.
While 63 percent of heart failure specialists and 58 percent of community cardiology clinicians believed this to be the responsibility of heart failure cardiologists, 66 percent of primary care providers felt it was up to them to initiate this discussion.
Still, it was the majority of heart failure specialists and community cardiology clinicians (89 percent) who referred heart failure patients to palliative care within the past twelve months, compared to just 21 percent of primary care physicians.
Of the 52 percent of survey participants who declared being hesitant talking about end-of-life care with their heart failure patients, 21 percent were under the impression that their patients were not ready to talk about the subject, 11 percent did not feel comfortable initiating the conversation, 9 percent were concerned they would destroy their patients’ sense of hope and for 8 percent of the respondents lack of time was an issue.
Cardiologist at the Mayo Clinic in Rochester, Minnesota, and the study’s lead researcher, Shannon Dunlay MD, MS, reported that healthcare providers expressed an interest in training courses that will help them develop their confidence and improve their skills to talk about palliative care with their heart failure patients. Dunlay said broaching the delicate subject of end-of-life care may ease anxiety for some patients and families, adding there was not evidence that it ruined hope.
Heart failure affects roughly 5.1 million Americans and according to statistics issued by the American Heart Association, about half of those succumb to the condition within five years of their diagnosis.
The main communication challenge lies in the fact that patients often have multiple healthcare providers in many health systems and hospitals, making it hard to establish a straightforward conversation according to Dunlay. Briefings between the various providers help clarifying patients’ preferences, and by including end-of-life conversations in routine, ongoing patient care, “patients and their families can feel more comfortable and confident in relaying their wishes to multiple providers.”
A National Institutes of Health Career Development Award helped fund the study, which was co-authored by Jilian L. Foxen, M.Ed.; Terese Cole, R.N., C.N.P.; Molly A. Feely, M.D.; Ann R. Loth, R.N., C.N.S.; Jacob J. Strand, M.D.; Keith M. Swetz, M.D., M.A.; Jean A. Wagner, M.S., C.N.P.; and Margaret M. Redfield, M.D. Author disclosures are on the abstract.
Source: American Heart Association