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

Healthcare professional and manager perceptions on drivers, benefits, and challenges of telemedicine: results from a cross-sectional survey in the Italian NHS

BACKGROUND

The Covid-19 pandemic provided new challenges and opportunities for patients and healthcare providers while accelerating the trend of digital healthcare transformation. This study explores the perspectives of healthcare professionals and managers on (i) drivers to the implementation of telemedicine services and (ii) perceived benefits and challenges related to the use of telemedicine across the Italian National Health Service.

METHODS

An online cross-sectional survey was distributed to professionals working within 308 healthcare organisations in different Italian regions. Quantitative and qualitative data were collected through a self-administered questionnaire (June-September 2021). Responses were analysed using summary statistics and thematic analysis.

RESULTS

Key factors driving the adoption of telemedicine have been grouped into (i) organisational drivers (reduce the virus spread-80%; enhance care quality and efficiency-61%), (ii) technological drivers (ease of use-82%; efficacy and reliability-64%; compliance with data governance regulations-64%) and (iii) regulatory drivers (regulations' semplification-84%). Nearly all respondents perceive telemedicine as useful in improving patient care (96%). The main benefits reported by respondents are shorter waiting lists, reduced Emergency Department attendance, decreased patient and clinician travel, and more frequent patient-doctor interactions. However, only 7% of respondents believe that telemedicine services are more effective than traditional care and 66% of the healthcare professionals believe that telemedicine can't completely substitute in-person visits due to challenges with physical examination and patient-doctor relationships. Other reported challenges include poor quality and interoperability of telemedicine platforms and scarce integration of telemedicine with traditional care services. Moreover, healthcare professionals believe that some groups of patients experience difficulties in accessing and using the technologies due to socio-cultural factors, technological and linguistic challenges and the absence of caregivers.

CONCLUSIONS

Respondents believe that telemedicine can be useful to complement and augment traditional care. However, many challenges still need to be overcome to fully consider telemedicine a standard of care. Strategies that could help address these challenges include additional regulations on data governance and reimbursements, evidence-based guidelines for the use of telemedicine, greater integration of tools and processes, patient-centred training for clinicians, patient-facing material to assist patients in navigating virtual sessions, different language options, and greater involvement of caregivers in the care process.

Pediatric nurse-patient communication practices at Pentecost Hospital, Madina: A qualitative study

Purpose

Delivering quality health care requires effective communication between health care providers and their patients. Nurse-patient effective communication remains a challenge in Ghana, despite criticism and concern expressed by the public. The study, therefore, aims to assess the effective nurse caregivers’ communication practices among pediatric nurses at Pentecost Hospital, Madina.

Methods

A qualitative exploratory and purposive sampling technique were used. Participants were engaged in Focus group discussions or face-to-face interviews. In all, 4 focus group discussions were conducted with 7 participants in each group and 15 face-face in-depth interviews, with a total sample size of 43. The data was content analyzed. Interviews were taped recorded and transcribed verbatim.

Results

The data analysis yielded 3 themes and 11 subthemes. The main themes were: effective communication practices, factors influencing effective communication, and attitudes towards effective communication. The study revealed how the participants communicated with patients who are deaf-mute, anxious, and those who refused treatment. In addition, participants reported how they used techniques such as silence, listening, and leading cues in communicating with patients and their relatives.

Conclusion

Effective communication between pediatric nurses, patients, and their parents is ascertained to be a key tool in the delivery of quality health care. However, several factors are found to hinder this therapeutic communication. Hence, further studies are needed to improve effective communication skills among pediatric nurses and their patients to enhance health care for children.

Palliative Care in Older People with Multimorbidities: A Scoping Review on the Palliative Care Needs of Patients, Carers, and Health Professionals

Although numerous studies have been conducted previously on the needs of cancer patients at the end of their life, there is a lack of studies focused on older patients with non-oncological complex chronic multipathologies. Examining these needs would help to gain a greater understanding of the profile of this specific population within the palliative care (PC) pathway and how the health and care systems can address them. The aim of this review was to identify the needs influencing PC among older patients with multimorbidities, their relatives or informal caregivers, and the health professionals who provide care for these patients. A scoping literature review guided by the Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist was carried out with literature searched in the Medline, Embase, CINAHL, WoS, Cochrane Library, PsycINFO, and Scopus databases from 2009 to 2022. Eighty-one studies were included, demonstrating a great variety of unaddressed needs for PC among chronic older patients and the complexity in detecting those needs and how to refer them to PC pathways. This review also suggested a scarcity of tools and limited pathways for professionals to satisfy their needs for these patients and their families, who often felt ignored by the system. Substantial changes will be needed in health and care systems at the institutional level, providing more specialized PC environments and systematizing PC processes.

Experiencing the possibility of near death on a daily basis: A phenomenological study of patients with chronic heart failure

BACKGROUND

Chronic heart failure (CHF) is a syndrome that greatly impacts people's lives. Due to the poor prognosis of CHF, together with the frequent exacerbations of symptoms, death is a topic that is very present in the lives of patients with CHF.

OBJECTIVE

To explore thoughts about death experienced by patients with chronic heart failure in their daily lives.

METHODS

A hermeneutic phenomenological study was carried out. Conversational interviews were conducted with 20 outpatients with chronic heart failure. Analysis of the responses was based on the method proposed by van Manen.

RESULTS

From the analysis, four main themes emerged: (1) Feeling afraid of the possibility of dying; (2) Acceptance of the possibility of death; (3) Desiring death for relief from suffering; and (4) Striving to continue living to enjoy family.

CONCLUSIONS

This study presents, as a novel finding, that people with CHF experience the possibility of near death on a daily basis. This experience, which they must encounter on their own, makes them afraid. In addition, some of them, in view of the discomfort they are living, wish to die, with some even considering committing suicide.

[Assessment tools for palliative care needs in patients with heart failure in general practice]

Palliative care of patients with non-oncological, chronic diseases is for the most part achieved by general practicioners (GP). Currently however standardized questionnaires are barely used by GPs to determine the demand. It is far more an intuitive, individual decision, at what time and to what extend a palliative treatment takes place at home. Based on an example of a patient with chronic heart failure, it's determined, if and with which assessment-tools the need for a (specialised) palliative care in general medicine can be detected.

Attitudes and practices towards palliative care in chronic heart failure: a survey of cardiovascular nurses and physicians

BACKGROUND

Heart failure is a chronic condition with various implications for individuals and families. Although the importance of implementing palliative care is recommended in best practice guidelines, implementation strategies are less clear.

AIMS

This study sought to; (1) determine Australian and New Zealand cardiovascular nurses and physicians' end of life care attitudes and specialist palliative care referral in heart failure and; (2) determine self-reported delivery of supportive care and attitudes towards service names.

METHODS

An electronic survey was emailed to members of four peak bodies and professional networks. Participants were also recruited through social media. Paper-based versions of the survey were completed by attendees of the 66th Cardiac Society of Australia and New Zealand Annual Scientific Meeting, August 2018.

FINDINGS

There were 113 completed responses included in the analyses. Participants were nurses (n = 75), physicians (n = 32) and allied health professionals (n = 4). Most (67%) reported they were comfortable with providing end of life care; however, fewer respondents agreed they received support for their dying patients and one-third experienced a sense of failure when heart failure progressed. Most (84-100%) participants agreed they would refer a heart failure patient later in the illness trajectory. There was a more favourable attitude towards the service name 'supportive care' than to 'palliative care'.

CONCLUSION

Comfort with end of life discussions is encouraging as it may lead to a greater likelihood of planning future care and identifying palliative care needs. Peer support and supervision may be useful for addressing feelings of failure. The use of needs-based assessment tools, adopting the service name 'supportive care' and further research focusing on primary palliative team-based approach is required to improve palliative care access.

IMPACT STATEMENT

Cardiovascular nurses and physicians are comfortable providing end of life care, but referrals to palliative care in the later stages of heart failure persists.

The impact of uncertainty on bereaved family's experiences of care at the end of life: a thematic analysis of free text survey data

Background

Inequities in the provision of palliative care for people with cardiac disease have been well documented in the literature. Despite experiencing significant palliative care needs, those with cardiac disease are less likely to be referred to specialist palliative care services and more likely to die in a hospital when compared to those with cancer. The unpredictable trajectory of heart failure has been identified as a key barrier to providing palliative care with many people experiencing a long period of stability with appropriate medical treatment. However, as the disease progresses and cardiac function deteriorates, exacerbations of acute decompensation can lead to what is often perceived to be ‘sudden’ death. The aim of this study is to explore the impact of uncertainty on how death is remembered by bereaved family members of people with heart disease.

Methods

Thematic analysis of free text collected during a postal survey of bereaved family’s experiences of healthcare services in the last 3 months of life using the New Zealand version of the VOICES questionnaire was undertaken. Data was analysed using a three-dimensional conceptual framework of “scientific uncertainty”.

Results

Eight hundred and twenty-seven completed questionnaires were received of which 12.6% (n = 105) indicated that they had cared for someone at the end of life with cardiac disease. Experiences of uncertainty were found to have a significant impact upon bereaved family. Four key themes were identified; distrust in healthcare professionals, stories left incomplete, loss, regret and missed opportunity and disempowerment.

Conclusions

This study highlights the ongoing impact on bereaved family when uncertainty is not made explicit in conversations regarding end of life for people with heart disease. Timely and sensitive conversations regarding the uncertainty of when death may occur is an important factor in ensuring that bereaved family are not left with unresolved narratives. Reframing how we think and talk about uncertainty in end of life care is important, as clinicians’ uncertainties may not always reflect or match up with families’ uncertainties. Being explicit about our inability to be certain about the timing of death may thus lead to a more positive and complete experience for bereaved family.

Referral Practices of Cardiologists to Specialist Palliative Care in Canada

BACKGROUND

Patients with heart failure have palliative care needs that can be effectively addressed by specialist palliative care (SPC). Despite this, SPC utilization by this patient population is low, suggesting barriers to SPC referral. We sought to determine the referral practices of cardiologists to SPC.

METHODS

Cardiologists across Canada were invited to participate in a survey about their referral practices to SPC. Associations between referral practices and demographic, professional, and attitudinal factors were analyzed using multiple and logistic regression.

RESULTS

The response rate was 51% (551 of 1082). Between 35.1% and 64.2% of respondents were unaware of referral criteria to local SPC services. Of the respondents, 29% delayed SPC referral because of prognostic uncertainty, and 46.8% believed that SPC prioritizes patients with cancer. In actual practice, nearly three-fourths of cardiologists referred late. Referral frequency was associated with greater availability of SPC services for patients with nonmalignant diseases (P = 0.008), a higher number of palliative care settings accepting patients receiving continuous infusions or pursuing acute care management (P < 0.001), satisfaction with services (P < 0.001), and less equation of palliative care with end-of-life care (P < 0.001). Early timing of referral was associated with greater availability of SPC services for patients with nonmalignant diseases and less equation of palliative care with end-of-life care.

CONCLUSIONS

The findings suggest that barriers to timely SPC referral include an insufficiency of services for patients with nonmalignant diseases especially in the outpatient setting, the perception that SPC services do not accept patients receiving cardiology-specific treatments, and a misperception about the identity of palliative care.

Healthcare Providers' Perceived Communication Barriers to Offering Palliative Care to Patients With Heart Failure: An Integrative Review

CONTEXT

Heart failure is a chronic complex syndrome that is common and burdensome. International clinical practice guidelines recommend that healthcare providers communicate palliative care options with patients with heart failure.

OBJECTIVES

The aim of this study was to conduct an integrative review to evaluate how healthcare providers perceived communication barriers to offering information to individuals in the palliative phase of heart failure.

METHODS

Four databases and the gray literature were searched from January 1987 to February 2017. Inclusion and exclusion criteria were applied. Studies were graded for strength and quality using a critical appraisal tool, and key themes were extracted and synthesized.

RESULTS

Ten articles met the full inclusion criteria. Most studies were qualitative or nonexperimental studies of good quality. Authors of several studies found that healthcare providers lacked basic knowledge about palliative care or did not possess sufficient knowledge to effectively provide care. Poor knowledge of palliative care created a barrier between the provider and the patient. Inadequate education or inexperience in palliative care led to the resistance of health providers to implementing a palliative approach.

CONCLUSIONS

The results of this review emphasize a lack of knowledge as a barrier to delivering palliative care. Healthcare providers caring for individuals with heart failure need palliative care knowledge, skills, and competencies to ensure that this vulnerable population receives holistic patient-centered care.

Utility of the integrated palliative care outcome scale (IPOS): a cross-sectional study in hospitalised patients with heart failure

AIM

The aim of this study was to evaluate the suitability and comprehensibility of the integrated palliative care outcome scale for the evaluation of palliative care needs in patients with heart failure.

METHODS AND RESULTS

This cross-sectional study investigated 100 heart failure patients (40 women, 60 men; median age 79 years) within the first few days of their hospitalisation by applying the integrated palliative care outcome scale (3-day recall period) and two additional self-developed questions about the suitability and comprehensibility of the integrated palliative care outcome scale. Clinically relevant somatic and psycho-emotional symptoms were reported very frequently (approximately 75% each), followed by communicational needs or practical issues. Ninety-five per cent of patients thought the integrated palliative care outcome scale very easy to understand, and 91% judged the integrated palliative care outcome scale suitable to assess palliative care needs.

CONCLUSION

The integrated palliative care outcome scale was well accepted by hospitalised patients with heart failure and identified a high burden of both physical and psycho-emotional symptoms. Screening for palliative care has to consider patients and their relatives alike, and should be part of a comprehensive care concept jointly integrated into clinical routine by primary and specialised palliative care teams.

Access and referral to palliative care for patients with chronic heart failure: A qualitative study of healthcare professionals

BACKGROUND

Palliative care for individuals with chronic heart failure is recommended for improving patients' symptoms, function and overall quality of life. Despite this mandate, there is limited access and referral to specialist palliative care for individuals with chronic heart failure.

OBJECTIVES

To explore healthcare professionals' perspectives on access to palliative care for patients with chronic heart failure, focussing on patient, provider and system factors.

METHODS

Cardiologists, palliative care specialists, heart failure nurses and palliative care nurses in acute and community care settings were interviewed using semi-structured interviews. Purposive and snowball sampling methods were used for recruitment. Interview data were analysed using thematic analysis. The COREQ checklist guided data collection and reporting.

RESULTS

There were 15 participants in the study, and the majority were female. Participants included palliative medicine physicians, a palliative care nurse consultant, cardiologists, a general practitioner and advanced heart failure nurses. The themes derived from the thematic analysis centred on patient, provider and system factors impacting access and referral to palliative care in the context of chronic heart failure. The patient themes were (a) patient and family preconception of palliative care and (b) patient's clinical profile influences referral. The provider themes were (a) conflict, (b) making decisions and (c) education needs, and the system themes were (a) accessing services and resources and (b) improving the model of care.

CONCLUSIONS

The patient's clinical profile, education needs of healthcare professionals and improving access to services and resources need to be considered to enhance palliative care access and referral as well as the interacting and influencing elements of the patient, provider and system.

Attitudes toward advance directives and prognosis in patients with heart failure: a pilot study

BACKGROUND/AIMS

Advance directives (ADs) in Korean patients with heart failure (HF) and the associations of attitude towards ADs and HF prognosis with ADs were initially assessed using the model of the Korean-Advance Directive (K-AD).

METHODS

Twenty-four patients with HF (age, 67.1 years; men, 58.3%; ejection fraction, 35.9%) participated. A pilot test to evaluate the feasibility of ADs and the possible associations of attitudes towards ADs and prognosis with end-of-life treatment preferences among patients with HF was conducted.

RESULTS

Fifteen patients (62.5%) completed the K-ADs. The major reason for incomplete K-AD was knowledge deficit. Patients valued "comfortable death" the most (45.4%), followed by "giving no burden to the family" (13.6%). Among treatment preferences, hospice care was preferred by the majority (66.7%), while cardiopulmonary resuscitation (CPR) was preferred by the minority (31.8%). Children (50.0%) were mostly appointed as a proxy, followed by the spouse (33.3%). More patients with moderately positive attitudes completed the K-ADs than their counterparts (70.0% vs. 57.1%). The 5-year survival rate was 69.2%; the patients who preferred CPR had a higher survival rate (70.6% vs. 68.5%) whereas those who preferred hospice care had a lower survival rate than their counterparts (70.7% vs. 75.2%).

CONCLUSION

The findings support the feasibility of the K-AD model, with a high acceptance rate in two-thirds of the sample. Further studies are warranted to investigate whether treatment preferences are associated with attitude towards ADs and/or HF prognosis using larger sample size.

The effects of teaching methods of palliative care on life pattern of old women with chronic pain

Chronic pain is among problems of old people and causes changes in their life pattern and processes. Teaching palliative care can help old people suffering from chronic pain to live an active life. The aim of this research was to determine effects of educating of palliative care on life pattern of elderly women with chronic pain. The present study was a Quasi-experimental design with pre-test and post test was conducted on 30 elderly women suffering from chronic pain in 2018 in Iran. The Questionnaire for evaluating the Pattern of Life with Pain in the elderly was filled before the intervention, group educating of palliative care was carried out using an educational package, and the questionnaire was completed again immediately and one and three months after. The data was analyzed using mean, standard deviations, Fisher's F test, and Greenhouse-Geisser and Bonferroni post-hoc test by employing SPSS- 16. Mean changes before teaching palliative care significantly differed from those of immediately and one and three months after the educational program (p = 0.0), (p = 0.004). There were significant differences between the stages of immediately and one month after the educational program and that of three months after it (p = 0.001), (p = 0.002). Concerning the personal life patterns, there were statistically significant differences between the stage immediately after the educational program and those before the intervention and three months after it (p = 0.005), (p = 0.000). Regarding the social life pattern, only the stage of one month after the educational program significantly differed from that of three months (p = 0.005). Mean growth in life pattern of the old women suffering from chronic pain in the stages after the intervention indicated the importance of and the necessity for palliative care during old age. Moreover, the success of this education three months after the educational program as compared to immediately and one month after it indicates that allocation of sufficient time plays a very important role in transferring information and in teaching methods of palliative care to old people.

Timely recognition of palliative care needs of patients with advanced chronic heart failure: a pilot study of a Dutch translation of the Needs Assessment Tool: Progressive Disease - Heart Failure (NAT:PD-HF)

BACKGROUND

The Needs Assessment Tool: Progressive Disease - Heart Failure (NAT:PD-HF) was developed to identify and triage palliative care needs in patients with chronic heart failure. A Dutch version is currently lacking.

AIMS

The aim of this study was to investigate the feasibility and acceptability of a Dutch NAT:PD-HF in chronic heart failure outpatients; and to gain preliminary data regarding the effect of the NAT:PD-HF on palliative care referral, symptoms, health status, care dependency, caregiver burden and advance directives.

METHODS

A mixed methods study including 23 outpatients with advanced chronic heart failure and 20 family caregivers was performed. Nurses conducted patient consultations using a Dutch translation of the NAT:PD-HF and rated acceptability. Before this visit and 4 months later, symptoms, health status, performance status, care dependency, caregiver burden and recorded advance directives were assessed. A focus group with participating nurses discussed barriers and facilitators towards palliative care needs assessment.

RESULTS

Acceptability was rated as 7 (interquartile range 6-7 points) on a 10-point scale. All patients had palliative care needs. In 48% actions were taken, including two patients referred to palliative care. Symptoms, performance status, care dependency, caregiver burden and advance directives were unchanged at 4 months, while health status deteriorated in patients completing follow-up ( n=17). Barriers towards palliative care needs assessment included feeling uncomfortable to initiate discussions and concerns about the ability to address palliative care needs.

CONCLUSIONS

The NAT:PD-HF identified palliative care needs in all participants, and triggered action to address these in half. However, training in palliative care communication skills as well as palliative care interventions should accompany the introduction of a palliative care needs assessment tool.

NETHERLANDS NATIONAL TRIAL REGISTER (NTR)

5616. http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5616.

Utilization of palliative care in patients hospitalized with heart failure: A contemporary national perspective

BACKGROUND

Despite advances in therapy, heart failure (HF) patients have significant symptom burden and poor quality of life. However, data on palliative care (PC) utilization in this population are scarce. We sought to assess national trends in PC utilization in patients admitted with acute HF.

METHODS

Adults hospitalized with HF without acute coronary syndrome were identified in the National inpatient sample. PC was identified using ICD-9-CM-Code V66.7. Trends in PC utilization, its predictors and its association with length-of-stay and cost were assessed.

RESULTS

A total of 939 680 HF patients were hospitalized with HF between 2003 and 2014. Of those,1.2% received PC during the hospitalization, with an upward trend in the use of PC over time (0.12% in 2003 to 3.6% in 2014, P < 0.001). Compared with patients who did not receive PC, those who had PC were older (79 ± 12 vs 69 ± 16 years), and had higher prevalence of Caucasian race (73.4% vs 51.8%), coronary disease (45.6% vs 39.3%), chronic renal disease (79.3% vs 42.8%), and pulmonary hypertension (28.3% vs 15.1%) (P < 0.001). In-hospital mortality (35.2% vs 2.2%), length-of-stay (9 ± 13 days vs 6 ± 6, P < 0.001), cost ($19 984 ± 42 922 vs $11 921 ± 18 175), and non-home discharges (46% vs 19.2%) (P < 0.001) were higher in the PC group. In-hospital mortality in PC group trended downward over time (69% in 2003 vs 29% in 2014, P < 0.001).

CONCLUSION

PC is being utilized in an increasing but overall small number of patients hospitalized with HF. Further research is needed to identify the optimal role and timing of PC in HF patients.

Palliative and end of life care in solid organ transplantation

Palliative care is an interprofessional approach that focuses on quality of life of patients who are facing life-threatening illness. Palliative care is consistently associated with improvements in advance care planning, patient and caregiver satisfaction, quality of life, symptom burden, and lower healthcare utilization. Most transplant patients have advanced chronic disease, significant symptom burden, and mortality awaiting transplant. Transplantation introduces new risks including perioperative death, organ rejection, infection, renal insufficiency, and malignancy. Numerous publications over the last decade identify that palliative care is well-suited to support these patients and their caregivers, yet access to palliative care and research within this population are lacking. This review describes palliative care and summarizes existing research supporting palliative intervention in advanced organ failure and transplant populations. A proposed model to provide palliative care in parallel with disease-directed therapy in a transplant program has the potential to improve symptom burden, quality of life, and healthcare utilization. Further studies are needed to elucidate specific benefits of palliative care for this population. In addition, there is a tremendous need for education, specifically for clinicians, patients, and families, to improve understanding of palliative care and its benefits for patients with advanced disease.

Is the content of guidelines/pathways a barrier for the integration of palliative Care in Chronic Heart Failure (CHF) and chronic pulmonary obstructive disease (COPD)? A comparison with the case of cancer in Europe

BACKGROUND

There is a notable inequity in access to palliative care (PC) services between cancer and Chronic Heart Failure (CHF)/Chronic Obstructive Pulmonary Disease (COPD) patients which also translates into discrepancies in the level of integration of PC. By cross-examining the levels of PC integration in published guidelines/pathways for CHF/COPD and cancer in Europe, this study examines whether these discrepancies may be attributed to the content of the guidelines.

DESIGN

A quantitative evaluation was made between integrated PC in published guidelines for cancer and CHF/COPD in Europe. The content of integrated PC in guidelines/pathways was measured using an 11 point integrated PC criteria tool (IPC criteria). A statistical analysis was carried out to detect similarities and differences in the level of integrated PC between the two groups.

RESULTS

The levels of integration between CHF/COPD and cancer guidelines/pathways have been shown to be statistically similar. Moreover, the quality of evidence utilized and the date of development of the guidelines/pathways appear not to impact upon the PC integration in the guidelines.

CONCLUSION

In Europe, the empirically observed imbalance in integration of PC for patients with cancer and CHF/COPD may only partially be attributed to the content of the guidelines/pathways that are utilized for the PC implementation. Given the similarities detected between cancer and CHF/COPD, other barriers appear to play a more prominent role.

Health care professionals' attitudes regarding palliative care for patients with chronic heart failure: an interview study

Background

Even though struggling with similar symptom burden, patients with chronic heart failure (CHF) receive less palliative care than patients suffering from malignant diseases. Researchers have found that this might be related to lack of knowledge about palliative care, insufficient interprofessional communication as well as the cyclic course of disease which makes accurate prognosis difficult. However, research findings have shown that patients with CHF benefit from palliative care. As there are no studies for the German health care system this study aimed to assess health care professionals’ attitudes regarding palliative care of CHF patients in order to identify barriers and facilitators for this patient group and hence to develop recommendations for improvement of CHF patients’ access to palliative care in Germany.

Method

Problem-centered interviews with 23 health care professionals involved in care of CHF patients (nurses: hospital, outpatient, heart failure, PC; physicians: hospital and resident cardiologists, general practitioners) were conducted and analysed according to Mayring’s qualitative content analysis.

Results

Most interviewees perceived a need for palliative care for CHF patients. Regarding barriers patients’, public’s, and professionals’ lack of knowledge of palliative care and CHF; shortcomings in communication and cooperation of different professional groups; inability of cardiology to accept medical limits; difficult prognosis of course of disease; and patients’ concerns regarding palliative care were described. Different attitudes regarding appropriate time of initiation of palliative care for CHF patients (late vs. early) were found. Furthermore, better communication and closer cooperation between different professional groups and medical disciplines as well as better education about palliative care and CHF for professionals, patients, and public were cited.

Conclusions

Palliative care for CHF patients is a neglected topic in both practice and research and should receive more attention. Barriers to palliative care for CHF patients might be overcome by: better education for the public, patients, and professionals, closer cooperation between the different professional groups involved as well as development of a joint agreement regarding the appropriate time to administer palliative care to CHF patients.

Trial registration

DRKS00007119.

Electronic supplementary material

The online version of this article (doi:10.1186/s12904-016-0149-9) contains supplementary material, which is available to authorized users.