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Godfrey S, Steiner JM, Damluji AA, Sampath R, Chuzi S, Warraich H, Krishnaswami A, Bernacki G, Goodlin S, Josephson R, Mulrow J, Doherty C. Palliative Care Education in Cardiovascular Disease Fellowships: A National Survey of Program Directors. J Card Fail 2024:S1071-9164(24)00116-7. [PMID: 38616006 DOI: 10.1016/j.cardfail.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/11/2024] [Accepted: 03/12/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Palliative care (PC) is an essential component of high-quality care for people with cardiovascular disease (CVD). However, little is known about the current state of PC education in CVD training, including attitudes toward integration of PC into training and implementation of PC by the program's leadership. METHODS We developed a nationwide, cross-sectional survey that queried education approaches, perspectives and barriers to PC education in general CVD fellowship training. The survey was distributed to 392 members of the American College of Cardiology Program Director (PD) listserv, representing 290 general CVD fellowships between 1/2023 and 4/2023. We performed descriptive and ꭕ2 analyses of survey data. RESULTS Of the program's representatives, 56 completed the survey (response rate = 19.3%). Respondents identified themselves as current PDs (89%), associate PDs (8.9%) or former PDs (1.8%), representing a diverse range of program sizes and types and regions of the country. Respondents reported the use of informal bedside teaching (88%), formal didactics (59%), online or self-paced modules (13%), in-person simulation (11%), and clinical rotations (16%) to teach PC content. Most programs covered PC topics at least annually, although there was variability by topic. We found no associations between program demographics and type or frequency of PC education. Most respondents reported dissatisfaction with the quantity (62%) or quality (59%) of the PC education provided. Barriers to PC education included an overabundance of other content to cover (36%) and perceived lack of fellow (20%) or faculty (18%) interest. Comments demonstrated the importance of PC education in fellowship, the lack of a requirement to provide PC education, difficulty in covering all topics, and suggestions of how PC skills should be taught. CONCLUSIONS In a national survey of CVD educational leadership concerning approaches to PC education in CVD training, respondents highlighted both challenges to implementation of formal PC curricula in cardiology training and opportunities for comprehensive PC education.
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Affiliation(s)
- Sarah Godfrey
- University of Texas Southwestern Medical Center, Dallas, TX.
| | | | - Abdulla A Damluji
- Inova Center of Outcomes Research, Falls Church, VA; Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | | | | | - Gwen Bernacki
- University of Washington Medical Center, Seattle, WA; Veterans' Administration of Puget Sound, Seattle, WA
| | - Sarah Goodlin
- Patient-Centered Education and Research, Oregon Health and Sciences University, Portland, OR
| | | | - John Mulrow
- Cardiology Clinic of San Antonio, San Antonio, TX
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Forouzandeh F, Alexander K, Forman DE, Kirkpatrick JN, Rich MW, Zieman S, Wenger NK. Cardiovascular Disease in the Older Adult: Where Are We 4 Decades Later? JACC. ADVANCES 2024; 3:100820. [PMID: 38435451 PMCID: PMC10906817 DOI: 10.1016/j.jacadv.2023.100820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 10/09/2023] [Accepted: 11/20/2023] [Indexed: 03/05/2024]
Abstract
The 1986 Bethesda Conference on Cardiovascular Disease (CVD) in the Elderly, co-chaired by Drs. Nanette Wenger, Frank Marcus, and Robert O'Rourke, delineated the anticipated social, political, ethical, economic and technological impact of an aging population on the incidence, prevalence, and management of CVD in the US and worldwide. In the ensuing 4 decades, older patients have come to comprise an increasingly large proportion of the CVD population, and there has been an explosion of research in all aspects of CVD affecting older adults. Correspondingly, Geriatric Cardiology is now an established field within cardiovascular medicine. In this communication, we provide a focused update on intersections between CVD and geriatrics from basic science to clinical practice, a review of major advances in diagnosis and treatment of older adults with CVD, and a preview of future research directions in the still evolving field of geriatric cardiology.
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Affiliation(s)
- Farshad Forouzandeh
- University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Karen Alexander
- Division of Cardiology, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Daniel E. Forman
- Divisions of Geriatrics and Cardiology, Department of Medicine, VA Pittsburgh Healthcare System, University of Pittsburgh, and the Pittsburgh Geriatrics, Research, Education, and Clinical Center (GRECC), Pittsburgh, Pennsylvania, USA
| | - James N. Kirkpatrick
- Division of Cardiology, Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, Washington, USA
| | - Michael W. Rich
- Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Susan Zieman
- Division of Geriatrics and Clinical Gerontology, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
| | - Nanette K. Wenger
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Emory Heart and Vascular Center, Emory Women’s Heart Center, Atlanta, Georgia, USA
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3
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McClung JA, Frishman WH, Aronow WS. The Role of Palliative Care in Cardiovascular Disease. Cardiol Rev 2024:00045415-990000000-00182. [PMID: 38169299 DOI: 10.1097/crd.0000000000000634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
The American Heart Association has recommended that palliative care be integrated into the care of all patients with advanced cardiac illnesses. Notwithstanding, the number of patients receiving specialist palliative intervention worldwide remains extremely small. This review examines the nature of palliative care and what is known about its delivery to patients with cardiac illness. Most of the published literature on the subject concern advanced heart failure; however, some data also exist regarding patients with heart transplantation, pulmonary hypertension, valvular disease, congenital heart disease, indwelling devices, mechanical circulatory support, and advanced coronary disease. In addition, outcome data, certification requirements, workforce challenges, barriers to implementation, and a potential caveat about palliative care will also be examined. Further work is required regarding appropriate means of implementation, quality control, and timing of intervention.
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Affiliation(s)
- John Arthur McClung
- From the Departments of Cardiology and Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY
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Abu-Aziz B, Alkasseh ASM, Bayuo J, Abu-Odah H. Towards the Provision of Palliative Care Services in the Intensive Coronary Care Units: Nurses' Knowledge, Training Needs, and Related-Barriers. Healthcare (Basel) 2023; 11:1781. [PMID: 37372899 DOI: 10.3390/healthcare11121781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/10/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Despite the notable benefits of palliative care (PC) for patients with chronic diseases, its delivery to people with cardiac problems, particularly in the Middle East region (EMR), remains a critical issue. There is a scarcity of research assessing nursing staff's needs and knowledge in providing PC to cardiac patients in the EMR. This study aimed to assess the level of knowledge and needs of PC among nurses towards the provision of PC in intensive coronary care units (ICCUs) in the Gaza Strip, Palestine. It also identified the barriers to the provision of PC services in ICCUs in the Gaza Strip. A hospital-based descriptive quantitative cross-sectional design was adopted to collect data from 85 nurses working in ICCUs at four main hospitals in the Gaza Strip. Knowledge about PC was collected using a developed questionnaire based on the Palliative Care Quiz Nursing Scale (PCQN) and Palliative Care Knowledge Test (PCKT). PC training needs and barriers were assessed using the PC Needs Assessment instrument. Approximately two-thirds of nurses did not receive any PC educational or training programs, which contributed to their lack of PC knowledge. Most nurses would like to enroll in PC training programs, such as family support and communications skills courses. Nurses reported that there was a high demand for PC guidelines and discharge planning for patients with chronic illnesses. Insufficient healthcare professionals' knowledge about PC and a staff shortage were the main barriers to integrating PC into the Gaza healthcare system. This study suggests incorporating PC into nursing curricula and in-service training, and it covers both basic and advanced PC principles. Intensive coronary care unit nurses need knowledge and training about PC, guidance, and support to provide appropriate care to patients with cardiovascular issues.
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Affiliation(s)
- Baraa Abu-Aziz
- Nasser Medical Complex Hospital, Ministry of Health, Gaza P.O. Box P860, Palestine
| | - Areefa S M Alkasseh
- Department of Midwifery, Nursing College, Islamic University of Gaza, Gaza P.O. Box P108, Palestine
| | - Jonathan Bayuo
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong 999077, China
| | - Hammoda Abu-Odah
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong 999077, China
- WHO Collaborating Centre for Community Health Services (WHOCC), School of Nursing, The Hong Kong Polytechnic University, Hong Kong 999077, China
- Nursing and Health Sciences Department, University College of Applied Sciences (UCAS), Gaza P.O. Box P860, Palestine
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Cabrera JA, Mota M, Pais C, Morais A. Deprescription in Palliative Care. Cureus 2023; 15:e39578. [PMID: 37378207 PMCID: PMC10292863 DOI: 10.7759/cureus.39578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2023] [Indexed: 06/29/2023] Open
Abstract
Individuals with limited life expectancy represent a significant proportion of healthcare consumers and are usually patients with multiple diseases and high levels of frailty. Polypharmacy and the prescription of long lists of drugs are frequent in patients with reduced life expectancy and often, as the patient's health status deteriorates, the list of drugs increases substantially as new medications are introduced to address new symptoms or complications. A key priority for healthcare professionals managing the care of these patients should be balancing the pharmacological approach to chronic diseases with the palliation of acute symptoms and complications. An important element of this process is to ensure that the benefit of any prescription decision outweighs potential risks. We reviewed the pros and cons of deprescribing drugs in individuals with limited life expectancy, how to identify the expected disease trajectory, which drugs are to be discontinued, identified some models trying to achieve rigorous deprescribing criteria, and the psychosocial effects of deprescribing in late phases of life. Deprescribing is not a one-time event but rather a continuous process that requires ongoing evaluation and monitoring. It is vital to continuously monitor and evaluate the pharmacological and non-pharmacological prescriptions for patients with chronic illnesses to align them with their goals of care and life expectancy.
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Affiliation(s)
- Joana A Cabrera
- Internal Medicine, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT
| | - Margarida Mota
- Infectious Diseases, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT
| | - Carmen Pais
- Internal Medicine, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, PRT
| | - Anabela Morais
- Internal Medicine, Centro Hospitalar de Trás os Montes e Alto Douro, Vila Real, PRT
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Dhande M, Myaskovsky L, Althouse A, Singh M, Weiss R, Shalaby A, Al-Khatib SM, Topoll A, Jain S, Saba S. Quality of Life and Type of Cardiac Resynchronization Therapy Device in Older Heart Failure Patients. J Palliat Med 2023; 26:481-488. [PMID: 36350362 PMCID: PMC10066768 DOI: 10.1089/jpm.2022.0217] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2022] [Indexed: 11/11/2022] Open
Abstract
Background: Cardiac resynchronization therapy (CRT) improves quality of life (QOL) in heart failure (HF) patients with reduced ejection fraction. Clinicians may have difficulty choosing between CRT with a pacemaker (CRT-P) or a defibrillator (CRT-D) for older patients. CRT-P devices are smaller, have more battery longevity, are less prone to erosions or recalls, and do not deliver shocks. These factors may impact patients' QOL, but data on such comparisons are lacking. Objectives: We examined the impact of CRT-P versus CRT-D on the QOL of older (≥75 years) HF patients who qualified for implantable cardioverter defibrillator therapy. Settings/Subjects/Measurements: We enrolled 101 CRT recipients and assessed QOL at baseline and at six-month post-implant using the Short Form Health Survey (SF-36) and the Minnesota living with heart failure (MLHF) questionnaires. Results: The average age of enrolled patients was 81 years, 27% were women, and 40 received a CRT-P device. After adjusting for baseline QOL score, age, sex, HF functional class, and the occurrence of adverse events, we found no significant differences in QOL outcomes between CRT-P and CRT-D recipients based on either the subscales or the composite scores for the SF-36 or MLHF questionnaires at six-months post-implantation. Conclusions: Older CRT-P and CRT-D recipients report comparable QOL scores six months after device implantation. Larger cohort studies with longer follow-up are needed to accurately assess potential QOL differences between CRT-D and CRT-P recipients to guide clinical decision making and ensure the right balance of risk versus benefit in these patients. Appropriate goals-of-care discussions are the corner stone of clinical decision making regarding defibrillator therapy. As such, even as the data stand at present, there is a need for more deliberate referral of older patients with HF to Palliative Care Specialists, or to Cardiologists trained in Palliative Care Medicine. clinicaltrials.gov listing: NCT03031847.
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Affiliation(s)
- Mehak Dhande
- Department of Medicine, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Larissa Myaskovsky
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Andrew Althouse
- Department of Medicine, Center for Research on Health Care Data Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Madhurmeet Singh
- Department of Medicine, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Raul Weiss
- Department of Medicine, Division of Cardiology, Ohio State University, Columbus, USA
| | - Alaa Shalaby
- Department of Medicine, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Medicine, Division of Cardiology, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Sana M. Al-Khatib
- Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Alicia Topoll
- Department of Medicine, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Medicine, Division of Palliative Care, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Sandeep Jain
- Department of Medicine, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Samir Saba
- Department of Medicine, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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7
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Goldwater D, Wenger NK. Patient-centered care in geriatric cardiology. Trends Cardiovasc Med 2023; 33:13-20. [PMID: 34758389 DOI: 10.1016/j.tcm.2021.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/21/2021] [Accepted: 11/03/2021] [Indexed: 02/01/2023]
Abstract
Geriatric cardiology involves providing cardiovascular care to older adults in relation to aging. Although cardiovascular diseases are the most common diseases faced by older adults, they often co-occur with numerous aging-related challenges, such as multimorbidity, frailty, polypharmacy, falls, functional and cognitive impairment, which present challenges to implementing standard disease-based treatment strategies. Faced with these complexities, patient-centered care in geriatric cardiology strives to direct all management toward the achievement of an individual's prioritized health and life goals by employing shared decision-making to align treatment with goals, utilizing stated goals to navigate situations of treatment uncertainty, and pro-actively mitigating aging-related risks. This fundamental change in cardiovascular medicine from disease-centered management to patient-centered goal-directed care is necessary to facilitate wellness, independence, and favorable quality of life outcomes in the older adult population.
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Affiliation(s)
| | - Nanette K Wenger
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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8
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Abbasi M, Eskandari N, Heidari A, Heidari M, Yoosefee S, Adeli SH, Kazemi A. A Thematic Analysis of Dimensions of Spiritual Care. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2022; 27:452-460. [PMID: 36524135 PMCID: PMC9745858 DOI: 10.4103/ijnmr.ijnmr_335_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/30/2021] [Accepted: 06/13/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND An overview of spiritual care studies can help reveal the dimensions of spiritual care and summarize the findings of available studies. Thus, we designed the present study based on existing studies to explain the dimensions of spiritual care. MATERIALS AND METHODS In this thematic analysis, we gathered the related articles published in Persian and English in the last 8 years (2013-2021) with the help of the keywords of Care, Support, Spirituality, Religion, Treatment, Hospice, and Palliative, and searching in electronic databases, including PubMed, Scopus, Web Of Sciences, Magiran, Islamic Science Citation (ISC), and Scientific Information Database (SID). We accurately studied 79 articles that met the inclusion criteria, and then the spiritual care components were extracted and coded, and finally, the codes were categorized as themes and sub-theme. RESULTS Thematic analysis of available studies revealed that the dimensions (theme) of spiritual care include: spiritual and religious assessment, developing a structure for providing spiritual care, establishing effective and supportive communication with the patient, training the patient, answering his questions, encouraging, maintaining, and improving social communications, encouraging the patient to live happily, helping the patient to achieve peace and calmness, supporting for spiritual rituals and activities, supporting and training the patient's family, and supporting the dying patient. CONCLUSIONS Spiritual care includes various and numerous dimensions. Considering the widespread dimensions of spiritual care, it seems necessary to design and plan appropriate studies to reveal other spiritual care dimensions from the perspective of patients and care providers in different cultures.
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Affiliation(s)
- Mohammad Abbasi
- Nursing Care Research Center, Department of medical Surgical Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Narges Eskandari
- Spiritual Health Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Akram Heidari
- Spiritual Health Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Morteza Heidari
- Spiritual Health Research Center, Qom University of Medical Sciences, Qom, Iran
- School of Health and Religion, Qom University of Medical Sciences, Qom, Iran
| | - Sadegh Yoosefee
- Spiritual Health Research Center, Qom University of Medical Sciences, Qom, Iran
- Neuroscience Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Seyed-Hasan Adeli
- Spiritual Health Research Center, Qom University of Medical Sciences, Qom, Iran
- Department of Internal Medicine, School of Medicine, Qom University of Medical Sciences, Qom, Iran
| | - Abdolhassan Kazemi
- Spiritual Health Research Center, Qom University of Medical Sciences, Qom, Iran
- Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Dzou T, Moriguchi JD, Doering L, Eastwood JA, Pavlish C, Pieters HC. "It's not something that's really been brought up": Opportunities and challenges for ongoing advance care planning discussions among individuals living with mechanical circulatory support. Heart Lung 2022; 54:34-41. [PMID: 35338939 DOI: 10.1016/j.hrtlng.2022.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 02/25/2022] [Accepted: 03/14/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND People living with mechanical circulatory support (MCS) are at risk for catastrophic complications that require advance care planning (ACP) as part of the preimplantation work up. Palliative care consultants are a mandatory and essential component of the MCS team tasked to enhance conversations. However, in reality, there is often a serious deficiency of ACP communication after the initial implant counseling. A better understanding of opportunities and challenges in ACP can mobilize intensive care unit and step-down nurses to bridge this gap in crucial communication. OBJECTIVES To identify and describe MCS individuals' perceptions of opportunities and challenges for ongoing ACP communication. METHODS A constructivist grounded theory study was conducted with 24 MCS individuals from 2 medical centers in Southern California. Semi-structured interviews were audio recorded, transcribed, and reviewed for accuracy. The data were systematically analyzed through 3 rounds of coding. RESULTS MCS clinicians, supportive others, and peers with MCS were identified as stakeholders in ongoing communication. Four categories of opportunities and challenges for ongoing ACP were synthesized from the narratives: identifying context and timing, sharing information, understanding of ACP, and assessing satisfaction. All participants reported a preference for MCS clinicians, including nurses, to initiate ACP conversations. CONCLUSION Understanding opportunities and challenges is key to facilitating ongoing ACP discussions among MCS patients. MCS-trained nurses are positioned to address the dearth of ongoing ACP by facilitating these sensitive discussions. The personal accounts of this sample serve to guide future research and structure training to prepare MCS clinicians for primary palliative care.
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Affiliation(s)
- Tiffany Dzou
- Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA.
| | - Jaime D Moriguchi
- Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
| | - Lynn Doering
- University of California, Los Angeles, School of Nursing, Factor Building, 700 Tiverton Dr., Los Angeles, California, 90095, USA
| | - Jo-Ann Eastwood
- University of California, Los Angeles, School of Nursing, Factor Building, 700 Tiverton Dr., Los Angeles, California, 90095, USA
| | - Carol Pavlish
- University of California, Los Angeles, School of Nursing, Factor Building, 700 Tiverton Dr., Los Angeles, California, 90095, USA
| | - Huibrie C Pieters
- University of California, Los Angeles, School of Nursing, Factor Building, 700 Tiverton Dr., Los Angeles, California, 90095, USA
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Aryafard H, Dehvan F, Albatineh AN, Dalvand S, Gheshlagh RG. Spiritual Health in Iranian Patients With Cardiovascular Diseases: A Systematic Review and Meta-analysis. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221108293. [PMID: 35694884 DOI: 10.1177/00302228221108293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This systematic review and meta-analysis aimed to evaluate the spiritual health status of Iranian patients with cardiovascular diseases. A literature search was conducted in national (MagIran and Scientific Information Database) and international (Scopus, PubMed, and Web of Science/ISI) databases from inception to December 2021. A random-effects model was used to estimate the pooled score of spiritual health. Based on the eligibility criteria, 22 articles were selected for the final analysis. The pooled score of spiritual health in Iranian patients with cardiovascular diseases was 61% (95% confidence interval: 54%-68%). In subgroup analysis, the pooled score in patients with heart failure was higher than other patients (67% vs. 58%). Publication bias was not significant (p = 0.554). Results indicated that the spiritual health of Iranian patients with cardiovascular diseases was moderate. Therefore, it is recommended that proper training be provided to these patients to enhance their adaptation to the complications of cardiovascular diseases.
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Affiliation(s)
- Hamdieh Aryafard
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Fazel Dehvan
- Clinical Care Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Ahmed N Albatineh
- Department of Community Medicine and Behavioural Sciences, Faculty of Medicine, Kuwait University, Kuwait
| | - Sahar Dalvand
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza G Gheshlagh
- Spiritual Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
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11
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Palliative Care for Older Adults Hospitalized for Stroke From the Informal Caregivers' Perspectives. J Cardiovasc Nurs 2022; 38:E110-E119. [PMID: 37027138 DOI: 10.1097/jcn.0000000000000923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND International guidelines have promoted palliative care (PC) for stroke survivors, but definition and implementation have been less than ideal. This practice gap is more prominent in China, where discussion of death remains taboo. AIM The aim of this study was to explore the perspectives of PC among caregivers of hospitalized patients with stroke. DESIGN AND SETTING A descriptive qualitative study design was used. Seventeen in-depth interviews with bedside caregivers in a first-rank tertiary hospital (general hospital with bed capacity exceeding 500) in China were analyzed thematically. RESULTS "Promoting comfort" stands at the core of PC and was operationalized by "meeting physical care needs," "ensuring communication," "providing psychoemotional care," "providing cognitive stimulation," and "avoiding discussion on death and dying." Caregivers who took care of older adults for a long time have described the use of "cognitive stimulation" to promote patients' positive emotional and cognitive reactions. All interviewees avoided mentioning "death" to protect patients' feelings, because they believed discussion of death was hurtful. CONCLUSIONS The high care demand for patients with stroke is a defining feature of stroke PC and should be recognized in addition to its prognosis estimation to promote this concept. The healthcare system should integrate PC as part of the regular service for patients with severe stroke to shift the focus of care from survival to promotion of comfort. A discussion of the dying process requires sensitivity and should be approached in a discussion of advanced PC planning, which views death as a meaningful transition.
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12
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Zaaqoq AM, Pottash M, Ahlstrom E, Brodie D. Postcardiotomy Extracorporeal Membrane Oxygenation: Narrative Review Navigating the Ethical Issues. J Cardiothorac Vasc Anesth 2021; 36:2628-2635. [PMID: 34763977 DOI: 10.1053/j.jvca.2021.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/18/2021] [Accepted: 10/08/2021] [Indexed: 11/11/2022]
Abstract
Postcardiotomy shock (PCS) is an uncommon and life-threatening surgical complication. Extracorporeal membrane oxygenation (ECMO) is the first line of mechanical circulatory support for treating PCS when medical therapies are insufficient. Reaching a "therapeutic ceiling" or a "bridge to nowhere" is a common clinical scenario in which medical avenues for recovery have been exhausted. These situations pose emotional and ethical challenges for patients, their surrogates, and clinicians. To shed light on these ethically challenging situations in PCS and potential approaches, the authors conducted a narrative review of the literature. Publications were utilized to describe current trends in the diagnosis and management of the patient with PCS, with particular emphasis on the therapeutic ceiling for life support. Most of the recommendations came from practice parameters or expert opinions to support specific interventions. The authors proposed a stepwise multidisciplinary approach to reduce PCS-associated ethical and emotional challenges. Their proposed algorithm was based on the likelihood of the need for ECMO support based on the mortality risk stratification of cardiac surgery. They suggested focused discussions around the commencement of ECMO or other life-sustaining therapies-ideally preoperatively at the time of consent-through shared decision-making and, subsequently, proactive multidisciplinary education and updates to the surrogate decision-makers relying on realistic prognosis and consideration of the patient wishes during the ECMO run.
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Affiliation(s)
- Akram M Zaaqoq
- Department of Critical Care Medicine, MedStar Washington Hospital Center, Georgetown University, Washington, DC; Department of Medicine, MedStar Washington Hospital Center, Georgetown University, Washington, DC.
| | - Michael Pottash
- Department of Medicine, MedStar Washington Hospital Center, Georgetown University, Washington, DC; Division of Palliative Medicine, MedStar Washington Hospital Center, Georgetown University, Washington, DC
| | - Eric Ahlstrom
- Department of Critical Care Medicine, MedStar Washington Hospital Center, Georgetown University, Washington, DC; Department of Medicine, MedStar Washington Hospital Center, Georgetown University, Washington, DC
| | - Daniel Brodie
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York; Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, New York
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13
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Chuang MH, Lee FN, Shiau YT, Shen HY, Lee CC, Chen SSS, Huang SJ. Physician Palliative Education Associated With High Use of Hospice Care Service. Am J Hosp Palliat Care 2021; 39:237-242. [PMID: 33960206 PMCID: PMC8793295 DOI: 10.1177/10499091211014160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Taiwan’s National Health Insurance provides coverage for palliative and hospice care. The following 10 types of diseases have been added to the National Health Insurance reimbursement regulation: end-stage cancer, motor neuron disease, organic psychosis, brain degeneration, heart failure, chronic airway obstruction diseases, other lung diseases, chronic liver disease and cirrhosis, acute renal failure, and chronic renal failure. Objective: This study aimed to determine the association between physicians’ palliative education and use of hospice care in hospitalized patients at the end of life. Design and Setting: A cross-sectional study in a Taipei community hospital. Participants: Patients who died between 2014 and 2019 were identified. The deceased had at least 1 of the 10 diseases covered by health insurance were included. Hospice care services included hospice ward care and hospice shared care. This study included 2,661 individuals. In total, 972 (36.5%) patients used hospice care services. Results: After adjusting for age, gender, and comorbidities, physicians’ palliative education was found to significantly associated with the use of hospice care (OR: 14.38, 95% CI: 10.90-18.98). Conclusions: Physicians’ palliative education was found to be an independent factor associated with higher use of hospice care. The findings suggest increasing palliative and hospice education among physicians so that they can ensure that their patients have high-quality end-of-life medical care in an aging society.
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Affiliation(s)
- Mei-Hsing Chuang
- Division of Family Medicine, 205690Taipei City Hospital Zhong Xiao Branch, Taipei.,Department of Family Medicine, School of Medicine, National Yang-Ming University, Taipei
| | - Fang-Niarn Lee
- Department of Internal Medicine, 205690Taipei City Hospital Zhong Xiao Branch, Taipei
| | - Yih-Tsong Shiau
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei City Hospital Zhong Xiao Branch, Taipei
| | - Hsiu-Yi Shen
- Department of Nursing, 38010Taipei City Hospital Zhong Xiao Branch, Taipei
| | - Chih-Ching Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei City Hospital Zhong Xiao Branch, Taipei.,Division of Palliative Medicine, 38010Taipei City Hospital Zhong Xiao Branch, Taipei
| | - Saint Shiou-Sheng Chen
- Division of Urology, 38010Taipei City Hospital Zhong Xiao Branch, Taipei.,Department of Urology, National Yang-Ming University School of Medicine, Taipei.,Commission for General Education, College of Applied Science, National Taiwan University of Science and Technology, Taipei.,University of Taipei, General Education Center, Taipei
| | - Sheng-Jean Huang
- Superintendent Office & Division of Neurosurgery, Department of Surgery, 38010Taipei City Hospital, Taipei.,Department of Surgery, College of Medicine, National Taiwan University, Taipei
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Fedson S. Rethinking the Meaning of Palliation in Heart Failure. Curr Heart Fail Rep 2020; 17:309-313. [PMID: 32876934 DOI: 10.1007/s11897-020-00483-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW Palliative care follows a philosophy of care that focuses upon the quality of life in patients with chronic or life-threatening illness. It also focuses upon the needs of their families which is a wider scope of care. Cardiovascular disease, and specifically heart failure, affects millions of patients and family members who have a symptom burden that exceeds that of many cancers and other chronic diseases. RECENTLY FINDINGS Historically palliative care has been viewed as an alternative to curative therapies, but over time, it is now recognized that it should be implemented earlier in the course of chronic diseases. Although non-oncologic patients now comprise over half of the patient seen by palliative care, patients with cardiovascular disease are still not being referred to palliative care. Palliative care goes beyond advance directives and end of life planning. There is a need to continue to expand the view of palliative care to encompass interventions that help improve the overall health of these patients, including their psychosocial well-being and quality of life. The collection of papers in this journal provides insight into the breadth of palliative care for patients with heart failure and other cardiovascular diseases.
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Affiliation(s)
- Savitri Fedson
- Section of Cardiology, Michael E DeBakey VA Medical Center, Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza, Suite 310D, Houston, TX, 77030, USA.
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Sullivan MF, Kirkpatrick JN. Palliative cardiovascular care: The right patient at the right time. Clin Cardiol 2020; 43:205-212. [PMID: 31829448 PMCID: PMC7021658 DOI: 10.1002/clc.23307] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/23/2019] [Accepted: 11/08/2019] [Indexed: 01/11/2023] Open
Abstract
In the increasingly complex world of modern medicine, relationship-centered, team-based care is important in geriatric cardiology. Palliative cardiovascular care plays a central role in defining the scope and timing of medical therapies and in coordinating symptom-targeted care in line with patient wishes, values, and preferences. Palliative care addresses advance care planning, symptom relief and caregiver/family support and seeks to ameliorate all forms of suffering, including physical, psychological, and spiritual. Although palliative care grew out of the hospice movement and has traditionally been associated with care at the end of life, the current model acknowledges that palliative care can be delivered concurrent with invasive, life-prolonging interventions. As the population ages, patients with serious cardiovascular disease increasingly suffer from noncardiac, multimorbid conditions and become eligible for interventions that palliate symptoms but also prolong life. Management of implanted cardiac support devices at the end of life, whether rhythm management devices or mechanical circulatory support devices, can involve a host of complexities in decisions to deactivate, timing of deactivation and even the mechanics of deactivation. Studies on palliative care interventions have demonstrated clear improvements in quality of life and are more mixed on life prolongation and cost savings. There is and will remain a dearth of clinicians with specialist palliative care training. Therefore, cardiovascular clinicians have a role to play in provision of practical, "primary" palliative care.
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