Care dependency in patients with chronic obstructive pulmonary disease and heart failure - a secondary data analysis of German prevalence studies

Care Dependency in Patients with Heart Failure: A Cross-Sectional Study in Spain

Background: Heart failure (HF) is a progressive and debilitating condition that represents an ever-growing problem for health systems worldwide. HF patients feel that they are a burden on their families, they feel socially isolated and have a low perception of their health. Accordingly, the objectives of this study were to: (1) to explore the profile of care dependency in a representative sample of Spanish HF patients through the Care Dependency Scale (CDS), and (2) to identify correlates of care dependency in this population. Material and Methods: We performed a cross-sectional study of 187 patients admitted for HF decompensation to the Hospital Clínico of Zaragoza (Spain). Results: Only 15% of our sample was highly or completely dependent on care from others. More specifically, our results indicate that HF patients felt a greater level of dependency on care from others when it comes to moving, getting dressed and undressed, maintaining good personal hygiene, participating in daily and recreational activities and being continent. Conclusions: We find association between the CDS categories that present a low score for care dependency in HF patients and the patients' physical deterioration.

Palliative care for patients with heart failure: facilitators and barriers - a cross sectional survey of German health care professionals

Background

Compared to patients with cancer, heart failure patients are seldom candidates for palliative care. Numerous studies have investigated reasons why heart failure patients do not receive palliative care; however, none of these studies have ever evaluated the situation in the German health care setting. This study aims to identify German healthcare providers’ (HCP) perception of barriers and facilitators to palliative care of patients with chronic heart failure.

Methods

We conducted an online-survey with 315 nurses and physicians of different medical disciplines.

Results

Even though heart failure patients’ need of palliative care and its advantages has been recognized, HCP see potential for development and improvement. A lack of knowledge about the content and measures of palliative care, poor communication and unclear responsibilities between medical disciplines, difficulties to determine the right time to initiate palliative care, and the feeling not to be prepared to discuss end-of-life issues with the patient has been identified as barriers. Further, HCP believe that patients and relatives do not possess adequate knowledge about the disease and its progression and are therefore unprepared in asking questions regarding palliative care. They rather tend to demand everything possible to be done in order prolong life, and are reluctant to accept that life is limited. Overall, HCP perceive that dying is a taboo subject within our society placing palliative care on the same level as assisted dying. In addition, results indicate that HCP have an inappropriate notion of ideal medicine fearing to lose patient and are worried about the appropriateness of PC remuneration.

Conclusions

In order to overcome the described barriers, HCP, patients, and relatives need to be educated in palliative care. Information and education encompassing the aim, content and measures of palliative care needs to be provided for all parties in order to optimize patient care, to foster communication between healthcare professionals, patients, and relatives, and to overcome perceived barriers.

Trial registration

DRKS00007119

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-016-1609-x) contains supplementary material, which is available to authorized users.

Relationship between pulmonary rehabilitation and care dependency in COPD

The aims of this study were to explore care dependency before and after pulmonary rehabilitation (PR) in patients with COPD (n=331) and to compare the response to PR between care dependent and independent patients. At baseline, 85 (25.7%) patients had a Care Dependency Scale (CDS) score ≤68 points and were considered as care dependent. CDS scores of these patients improved after PR (p<0.001). After PR, CDS score of 38 (44.7%) patients with a baseline CDS score ≤68 points increased to >68 points. Patients with a baseline CDS score ≤68 points or >68 points showed after PR a comparable improvement in COPD Assessment Test, Hospital Anxiety and Depression Scale and 6-min walk distance (all p<0.05).

TRIAL REGISTRATION NUMBER

NTR3416 (The Netherlands).