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Teuteberg W, Maurer M. Palliative Care Throughout the Journey of Life With a Left Ventricular Assist Device. Circ Heart Fail 2018; 9:CIRCHEARTFAILURE.116.003564. [PMID: 27758812 DOI: 10.1161/circheartfailure.116.003564] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Winifred Teuteberg
- From the Department of Medicine, University of Pittsburgh School of Medicine, PA (W.G.T.); and Department of Medicine, Columbia University Medical Center, New York Presbyterian Hospital, NY (M.M.).
| | - Mathew Maurer
- From the Department of Medicine, University of Pittsburgh School of Medicine, PA (W.G.T.); and Department of Medicine, Columbia University Medical Center, New York Presbyterian Hospital, NY (M.M.)
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Wentlandt K, Dall'Osto A, Freeman N, Le LW, Kaya E, Ross H, Singer LG, Abbey S, Clarke H, Zimmermann C. The Transplant Palliative Care Clinic: An early palliative care model for patients in a transplant program. Clin Transplant 2016; 30:1591-1596. [PMID: 27910190 DOI: 10.1111/ctr.12838] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2016] [Indexed: 12/20/2022]
Abstract
Although patients within a transplant program are awaiting or have received disease modifying or curative treatment, they are also facing advanced illness and the possibility of death. The involvement of specialized palliative care services for these patients may improve symptom management and facilitate advance care planning. However, patients in organ transplantation programs have difficulty accessing palliative care resources and often do so only sporadically in the inpatient setting. Currently, there is little access to ambulatory palliative care for these patients and there have been no descriptions of programs delivering such care in the medical literature. We outline the development and structure of a Transplant Palliative Care Clinic within the University Health Network's Multi-Organ Transplant Program, in Toronto, Canada. This information may be helpful for others aiming to provide early, integrated palliative care to patients awaiting and receiving organ transplantation.
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Affiliation(s)
- Kirsten Wentlandt
- Department of Supportive Care, University Health Network, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Angela Dall'Osto
- Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada
| | - Nicole Freeman
- Department of Family Medicine [Windsor Program], Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Lisa W Le
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Ebru Kaya
- Department of Supportive Care, University Health Network, Toronto, ON, Canada.,Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Heather Ross
- Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada.,Division of Cardiology, Department of Medicine, University of Toronto, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada
| | - Lianne G Singer
- Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada.,Division of Respirology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Susan Abbey
- Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Hance Clarke
- Pain Research Unit and the Transitional Pain Service, Department of Anaesthesia, University Health Network, Toronto, ON, Canada.,Department of Anaesthesia, University of Toronto, Toronto, ON, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, University Health Network, Toronto, ON, Canada.,Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Campbell Family Cancer Research Institute, Ontario Cancer Institute, Toronto, ON, Canada
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Alonso W, Hupcey JE, Kitko L. Caregivers' perceptions of illness severity and end of life service utilization in advanced heart failure. Heart Lung 2016; 46:35-39. [PMID: 27788935 DOI: 10.1016/j.hrtlng.2016.09.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 09/02/2016] [Accepted: 09/26/2016] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To assess perceptions of illness severity and terminality in caregivers of advanced heart failure (HF) patients and how these perceptions influence utilization of palliative care and end-of life services. BACKGROUND HF is a terminal disease; yet patients and caregivers do not understand the severity of HF or acknowledge disease terminality. METHODS This study was conducted using a qualitative design with in-depth interviews and content analysis. RESULTS Most caregivers did not understand the severity of HF (68%) or disease terminality (67%). Patients were more likely to receive services when their caregivers expressed an understanding of illness severity and/or terminality. CONCLUSIONS Inclusion of caregivers in discussions of goals of care, advance care planning, and palliative care and end-of-life services with patients and providers is imperative.
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Affiliation(s)
- Windy Alonso
- Pennsylvania State University College of Nursing, 1300ASB/A110 90 Hope Drive, Hershey, PA 17033, USA.
| | - Judith E Hupcey
- Pennsylvania State University College of Nursing, 1300ASB/A110 90 Hope Drive, Hershey, PA 17033, USA
| | - Lisa Kitko
- Penn State College of Nursing, 307H Nursing Sciences Building, University Park, PA 16802, USA
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van der Wal MHL, Strömberg A, van Veldhuisen DJ, Jaarsma T. Heart failure patients' future expectations and their association with disease severity, quality of life, depressive symptoms and clinical outcomes. Int J Clin Pract 2016; 70:469-76. [PMID: 27125731 DOI: 10.1111/ijcp.12802] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Although treatment of heart failure (HF) patients has improved, prognosis still remains poor. Current HF Guidelines recommend communication about prognosis with all patients. Little is known about HF patients' awareness of their shortened life expectancy. AIM To explore HF patients' future expectations and to examine whether these expectations are associated with disease severity, quality of life, depressive symptoms and clinical outcomes. METHOD Patients randomised to the intervention groups of the COACH study, who were at the end of HF hospitalisation, were asked about their future expectations. Patients were divided into three groups: patients expecting improvement/stabilisation, patients expecting deterioration and those not knowing what to expect. Depressive symptoms were measured by CES-D and quality of life with the Ladder of Life and RAND-36. RESULTS Six hundred and seventy eight patients (age 70 ± 12; 41% female patients; LVEF 33% ± 15) participated in the study. Most patients (56%, N = 380) expected improvement or stabilisation, 8% (N = 55) expected deterioration and 21% (N = 144) did not know what to expect for the future. Patients who expected to deteriorate were significantly older, experienced a lower quality of life and more depressive symptoms compared with patients in the other two groups. They also had a higher mortality rate, both after 18 and 36 months, and had more HF admissions. No association with severity of the disease (NYHA-class, LVEF, BNP levels) was found. CONCLUSION Many hospitalised HF patients are not aware of their poor prognosis. Depressive symptoms, poor quality of life, increased mortality and rehospitalisation were related to expected deterioration. Improvement of communication about prognosis with HF patients is needed in the future.
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Affiliation(s)
- M H L van der Wal
- Department of Social and Welfare Studies, Linköping University, Linköping, Sweden
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - A Strömberg
- Department of Medical and Health Sciences, Division of Nursing and Department of Cardiology, Linköping University, Linköping, Sweden
- UCI Program in Nursing Science, University of California Irvine, Irvine, CA, USA
| | - D J van Veldhuisen
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - T Jaarsma
- Department of Social and Welfare Studies, Linköping University, Linköping, Sweden
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Vic., Australia
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Abstract
The number of patients with heart failure is growing; the associated morbidity and mortality remains dismal. Advance care planning, end-of-life conversations, and palliative care referrals are appropriate, but do not occur regularly. Palliative care focuses on patients and families from diagnosis, to hospice, death, and bereavement. It is delivered as basic palliative care by all providers and by specialty-certified palliative care specialists. Nurses are well-positioned to provide basic. Nurses are also instrumental in initiating referrals to the specialized palliative care team as the patient's needs become too complex or the disease progresses and the patient approaches the end of life.
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Hill L, McIlfatrick S, Taylor BJ, Dixon L, Cole BR, Moser DK, Fitzsimons D. Implantable cardioverter defibrillator (ICD) deactivation discussions: Reality versus recommendations. Eur J Cardiovasc Nurs 2015; 15:20-9. [DOI: 10.1177/1474515115584248] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 04/02/2015] [Indexed: 01/06/2023]
Affiliation(s)
- Loreena Hill
- Ulster University, Newtownabbey, UK
- Belfast Health and Social Care Trust, Royal Group of Hospitals, UK
| | - Sonja McIlfatrick
- Ulster University, Newtownabbey, UK
- All Ireland Institute of Hospice and Palliative Care, Our Lady’s Hospice and Care Services, Harold’s Cross, Dublin, Ireland
| | | | - Lana Dixon
- Belfast Health and Social Care Trust, Royal Group of Hospitals, UK
| | - Ben R Cole
- Belfast Health and Social Care Trust, Royal Group of Hospitals, UK
| | - Debra K Moser
- Ulster University, Newtownabbey, UK
- University of Kentucky, College of Nursing, Lexington, USA
| | - Donna Fitzsimons
- Ulster University, Newtownabbey, UK
- Belfast Health and Social Care Trust, Royal Group of Hospitals, UK
- All Ireland Institute of Hospice and Palliative Care, Our Lady’s Hospice and Care Services, Harold’s Cross, Dublin, Ireland
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Heart failure and palliative care: training needs assessment to guide priority learning of multiprofessionals working across different care settings. Curr Opin Support Palliat Care 2015; 9:31-7. [PMID: 25581450 DOI: 10.1097/spc.0000000000000113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW International bodies acknowledge that palliative care principles and access to palliative care services should be offered to persons living with and dying from advanced illness such as heart failure. Without an appropriately trained workforce, however, appropriate goals of care and associated reductions in hospital utilizations may not be feasible.Marie Curie Cancer Care, British Heart Foundation Scotland and NHS Greater Glasgow and Clyde are working in partnership to improve the quality and access to palliative care for patients and their caregivers living with and dying from advanced heart failure. A training needs assessment has been undertaken as part of this programme in order to inform the development of training specific to heart failure and palliative care. RECENT FINDINGS The results of the training needs assessment showed that the majority of respondents had some level of training needs to underpin their existing knowledge and skills in relation to palliative care, heart failure or both. SUMMARY Well trained professionals will improve the coordination, earlier identification, quality of care provision and communication between all stakeholders. In doing so, the opportunity to facilitate preferred care wishes and preferred place of care for patients and families is optimised. Without this aligning, clinical practice with national guidance is not feasible.
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