Feder S, Iannone L, Lendvai D, Zhan Y, Akgün K, Ersek M, Luhrs C, Allen LA, Bekelman DB, Goldstein N, Kavalieratos D. Clinician Insights into Effective Components, Delivery Characteristics, and Implementation Strategies of Ambulatory Palliative Care for People with Heart Failure: A Qualitative Analysis.
J Card Fail 2024:S1071-9164(24)00265-3. [PMID:
39098653 DOI:
10.1016/j.cardfail.2024.07.009]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/28/2024] [Accepted: 07/02/2024] [Indexed: 08/06/2024]
Abstract
OBJECTIVES
To elicit perspectives from specialist palliative care (SPC) and cardiology clinicians on the necessary components, delivery characteristics, and implementation strategies of successful ambulatory SPC for people with heart failure (HF).
BACKGROUND
Palliative care is a recommended component of guideline-directed care for people with HF. However, optimal strategies to implement SPC within ambulatory settings are unknown.
METHODS
We conducted a qualitative descriptive study comprised of semi-structured interviews with SPC and cardiology clinicians at Veterans Affairs Medical Centers (VAMCs) with the highest number of ambulatory SPC consultations within the VA system among people with HF from 2021-2022. Clinicians were asked how they provided ambulatory SPC and what they felt were the necessary components, delivery characteristics, and implementation strategies of care delivery. Interviews were analyzed using directed content analysis.
RESULTS
We interviewed 14 SPC clinicians and 9 cardiology clinicians at seven national VAMCs; 43% were physicians and 48% were advanced practice registered nurses/physician associates. Essential components of ambulatory SPC encompassed discussion of goals of care (e.g., prognosis, advance directives) and connecting patients/caregivers to resources (e.g., homecare). Preferred delivery characteristics included integrated (i.e., embedded) approaches to SPC delivery, standardized patient selection and referral procedures, and formalized procedures for handoffs to and from SPC. Strategies that addressed SPC implementation included deploying palliative champions, educating non-SPC clinicians on the value of ambulatory SPC for people with HF, and developing ambulatory models through leadership support.
CONCLUSIONS/IMPLICATIONS
Facilitating the broader adoption of ambulatory SPC among people with HF may be achieved by prioritizing these mutually valued and necessary features of SPC delivery.
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