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Singh GK, Ivynian SE, Davidson PM, Ferguson C, Hickman LD. Elements of Integrated Palliative Care in Chronic Heart Failure Across the Care Continuum: A Scoping Review. Heart Lung Circ 2021; 31:32-41. [PMID: 34593316 DOI: 10.1016/j.hlc.2021.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 05/09/2021] [Accepted: 08/01/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Individuals with chronic heart failure experience high symptom burden, reduced quality of life and high health care utilisation. Although there is growing evidence that a palliative approach, provided concurrently with usual treatment improves outcomes, the method of integrating palliative care for individuals living with chronic heart failure across the care continuum remains elusive. AIM To examine the key elements of integrated palliative care recommended for individuals living with chronic heart failure across the care continuum. DESIGN Scoping review. DATA SOURCES Databases searched were CINAHL, Ovid MEDLINE, Scopus and OpenGrey. Studies written in English and containing key strategic elements specific to chronic heart failure were included. Search terms relating to palliative care and chronic heart failure and the Joanna Briggs Institute methodology for scoping reviews was used. RESULTS Seventy-nine (79) articles were selected that described key elements to integrate palliative care for individuals with chronic heart failure. This review identifies four levels of key strategic elements: 1) clinical; 2) professional; 3) organisational and 4) system-level integration. Implementing strategies across these elements facilitates integrated palliative care for individuals with chronic heart failure. CONCLUSIONS Inter-sectorial collaborations across systems and the intersection of health and social services are essential to delivering integrated, person-centred palliative care. Further research focussing on patient and family needs at a system-level is needed. Research with strong theoretical underpinnings utilising implementation science methods are required to achieve and sustain complex behaviour change to translate key elements.
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Affiliation(s)
- Gursharan K Singh
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Qld, Australia; Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology (QUT), Brisbane, Qld, Australia.
| | - Serra E Ivynian
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Patricia M Davidson
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA & Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Caleb Ferguson
- School of Nursing & Midwifery, Western Sydney University, Penrith, NSW, Australia; Western Sydney Local Health District, Blacktown Hospital, Sydney, NSW, Australia
| | - Louise D Hickman
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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Cassidy L, Hill L, Fitzsimons D, McGaughey J. The impact of psychoeducational interventions on the outcomes of caregivers of patients with heart failure: A systematic review and meta-analysis. Int J Nurs Stud 2020; 114:103806. [PMID: 33248290 DOI: 10.1016/j.ijnurstu.2020.103806] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Heart failure is a global health care problem that causes a significant economic burden. Despite medical advancements, it's prognosis remains poor as many patients with heart failure experience symptoms that negatively impact Quality of Life. Caregivers are often responsible for helping and supporting family members manage their heart failure symptoms at home. In addition to managing their own medical problems and maintaining social and personal lives, significant burden and stress can occur. At present, caregivers receive little guidance or information to support them in their caregiving role. OBJECTIVES This review aims to determine the impact of psychoeducational interventions on the outcomes of caregivers of patients with heart failure. DESIGN Systematic review and meta-analysis. DATA SOURCE Five electronic databases: PsycINFO, Medline, CINAHL Plus, EMBASE and SCOPUS were searched from June 2007 to August 2019. REVIEW METHODS The conduct and reporting of this review was based on the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The Cochrane Risk of Bias Tool was used to assess the risk of bias amongst randomised controlled trials, and the Newcastle Ottawa Scale was used to assess risk of bias in one quasi-experimental study. RESULTS Ten articles met the inclusion criteria, consisting of seven studies, with a total sample size of 953 participants. The pooled result from two studies, conducted in America and China, reported that psychoeducational interventions significantly reduced depression at six months' follow-up (SMD -0.82; 95% CI -1.17 to -0.47; p = 0.73, I2 =0%). The pooled result from two studies conducted in Sweden and Taiwan showed a significant improvement in heart failure knowledge at six months' follow-up (SMD 0.97; 95% CI 0.70 to 1,25; p < 0.00001, I2 =0%). Finally, pooled results from three studies conducted in Sweden, China and Taiwan found a significant improvement in Quality of Life at 3 months' follow- up (SMD 0.25; 95% CI 0.25 to 0.48; p = 0.03). The three most common intervention components included: group based educational sessions, telemonitoring and telephone support, and written resources. CONCLUSIONS There was no specific type of psychoeducational intervention found to have a significant impact on caregiver outcomes, as interventions were heterogeneous consisting of multiple components. Further research is needed to determine the effectiveness of individual and combined components to identify the ideal intervention format and design for caregivers of patients with heart failure.
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Affiliation(s)
- Lorna Cassidy
- Queen's University Belfast, School of Nursing and Midwifery, Medical Biology Centre, 97 Lisburn Road, Belfast BT9 7BL, Northern Ireland.
| | - Loreena Hill
- Queen's University Belfast, School of Nursing and Midwifery, Medical Biology Centre, 97 Lisburn Road, Belfast BT9 7BL, Northern Ireland.
| | - Donna Fitzsimons
- Queen's University Belfast, School of Nursing and Midwifery, Medical Biology Centre, 97 Lisburn Road, Belfast BT9 7BL, Northern Ireland; All-Ireland Institute for Hospice And Palliative Care, Our Lady's Hospice and Care Services, Harold's Cross Rd, Harold's Cross, Dublin, Ireland.
| | - Jennifer McGaughey
- Queen's University Belfast, School of Nursing and Midwifery, Medical Biology Centre, 97 Lisburn Road, Belfast BT9 7BL, Northern Ireland.
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Hjelmfors L, van der Wal MHL, Friedrichsen M, Milberg A, Mårtensson J, Sandgren A, Strömberg A, Jaarsma T. Optimizing of a question prompt list to improve communication about the heart failure trajectory in patients, families, and health care professionals. BMC Palliat Care 2020; 19:161. [PMID: 33059632 PMCID: PMC7566035 DOI: 10.1186/s12904-020-00665-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 10/01/2020] [Indexed: 12/28/2022] Open
Abstract
Background The aim of this study was to optimize a Question Prompt List which is designed to improve communication about the heart failure trajectory among patients, family members, and health care professionals. Methods Data were collected in a two-round Delphi survey and a cross-sectional survey, including patients with heart failure, their family members, and health care professionals working in heart failure care in Sweden and the Netherlands. Acceptability for and demand of the Question Prompt List were assessed. Results A total of 96 patients, 63 family members and 26 health care professionals participated in the study. Regarding acceptability, most of the original questions were found to be relevant by the participants for inclusion in the Question Prompt List but some cultural differences exist, which resulted in two versions of the list: a Swedish version including 33 questions and a Dutch version including 38 questions. Concerning demand, participants reported that they were interested in discussing the questions in the revised Question Prompt List with a physician or a nurse. Few patients and family members reported that they were worried by the questions in the Question Prompt List and hence did not want to discuss the questions. Conclusions This Question Prompt List has successfully been adapted into a Swedish version and a Dutch version and includes questions about the HF trajectory which patients, their families, and health care professionals perceived to be relevant for discussion in clinical practice. Overall, patients and family members were not worried about the content in the Question Prompt List and if used in accordance with patients’ and family members’ preferences, the Question Prompt List can help to improve communication about the heart failure trajectory.
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Affiliation(s)
- Lisa Hjelmfors
- Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health, Linköping University, Linköping, Sweden.
| | - Martje H L van der Wal
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Maria Friedrichsen
- Palliative Education & Research Centre, Vrinnevi hospital, Norrköping, Sweden.,Department of Advanced Palliative Home Care, Vrinnevi hospital, Norrköping, Sweden
| | - Anna Milberg
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Linköping University, Linköping, Sweden
| | - Jan Mårtensson
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Anna Sandgren
- Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Anna Strömberg
- Department of Health, Medicine and Caring Sciences and Department of Cardiology, Linköping University, Linköping, Sweden
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health, Linköping University, Linköping, Sweden
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Jaarsma T, Hill L, Strömberg A. What is what? From a palliative care approach to specialized palliative care in heart failure management. Eur J Heart Fail 2020; 22:2347-2348. [PMID: 32298530 DOI: 10.1002/ejhf.1823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 03/24/2020] [Indexed: 12/28/2022] Open
Affiliation(s)
- Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Julius Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Loreena Hill
- School of Nursing and Midwifery, Queen's University, Belfast, UK
| | - Anna Strömberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Cardiology, Linköping University Hospital, Linköping University, Linköping, Sweden
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Abstract
Heart failure (HF) professionals are managing an older population with multiple, often interconnected comorbidities. The average age of the HF patient has increased substantially and many have a number of comorbidities. For the older HF patient, diligent planning of care has the potential to reduce hospitalization, improve quality of life and mortality; nevertheless, this vital component is often overlooked. Frailty, cachexia, sarcopenia, and cognitive impairment are all common in the older HF patient and require special care considerations. Many older HF patients live for many years with troublesome symptoms that could be better addressed through the incorporation of a palliative approach to care. Effective care plans can help patients maximize their health potential through both lifestyle and pharmacological interventions. However, current evidence remains scarce on what constitutes an optimal plan, therefore further studies are urgently needed. We review the care that could be implemented for the complex older HF patient with comorbidities.
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Affiliation(s)
- Loreena Hill
- School of Nursing and Midwifery, Queen's University, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, UK
| | - Matthew A Carson
- School of Nursing and Midwifery, Queen's University, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, UK
| | - Cristiana Vitale
- Department of Medical Sciences, Centre for Clinical and Basic Research, IRCCS San Raffaele Pisana, Via della Pisana, 235 00163 Rome, Italy.,St George's Hospital, Cranmer Terrace, SW17 ORE, London, UK
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Coats AJ. Figures of the Heart Failure Association (HFA): Prof. Dr. Tiny Jaarsma, HFA Board Member (2018–2020), Coordinator Patient Care: Management and Delivery Committee and Co‐Chair HFA Task Force on Palliative Care. Eur J Heart Fail 2019; 22:3-5. [DOI: 10.1002/ejhf.1705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 11/09/2019] [Indexed: 01/08/2023] Open
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