Characteristics and Trends Among Patients With Cardiovascular Disease Referred to Palliative Care

Warraich, Haider J.; Wolf, Steven; Mentz, Robert J.; Rogers, Joseph G.; Samsa, Greg; Kamal, Arif H.

doi:10.1001/jamanetworkopen.2019.2375

Cited by 53 publications

(37 citation statements)

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“…According to the Clinical Practice Research Datalink in England, in 2009, only 234 (7%) of 3122 patients with heart failure were given palliative care by family physicians or referred to special palliative care services, compared to 3669 (48%) of 7608 cancer patients [15]. Also, one study showed that patients with cardiovascular disease had very advanced disease when referred to palliative care [18].…”

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confidence: 99%

Knowledge, attitude, confidence, and educational needs of palliative care in nurses caring for non-cancer patients: a cross-sectional, descriptive study

2020

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Background: Palliative care is a patient-centred, integrated approach for improving quality of life for both patients facing life-threatening illnesses and for their families. Although there has been increased interest in palliative care for non-cancer patients, the palliative care competency of nurses who care for non-cancer patients has rarely been investigated. This study described the palliative care knowledge, attitude, confidence, and educational needs in nurses who care for patients with congestive heart failure, stroke, end-stage renal disease, and end-stage liver disease; explored the relationships between those variables; and identified factors affecting nurses' palliative care confidence. Methods: A cross-sectional, descriptive, correlational design was employed; data collection was conducted at a tertiary hospital in Seoul, Korea. Nurses who were working in general wards and intensive care units (N = 102) completed valid and reliable self-administered questionnaires. Descriptive statistics, frequencies, independent t-tests, one-way ANOVA, Pearson's correlations, and multiple regression were conducted to analyse the data. Results: Nurses' palliative care knowledge level was low (9.73 ± 2.10; range = 0-20) and their attitude toward palliative care was moderate (87.97 ± 6.93, range: 30-120). Knowledge was significantly correlated with attitude (r = .29, p = .003). Nurses were highly confident in pain and symptom management but demonstrated high educational needs for managing human and material resources to provide palliative care. Previous training in hospice, palliative, and EOL care was a significant and modifiable factor that affected nurses' confidence (std. β = 0.25, p = .010). Conclusions: To facilitate high-quality palliative care for non-cancer patients and families, nursing education programs should be developed to address nurses' knowledge level, confidence level, and educational needs. This study provides relevant information that can be utilised to develop palliative care educational programs for nurses who care for non-cancer patients.

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Section: Introductionmentioning

confidence: 99%

Knowledge, attitude, confidence, and educational needs of palliative care in nurses caring for non-cancer patients: a cross-sectional, descriptive study

2020

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“…The characterization of functional status using the palliative performance score in such a large, multicenter population is unique, to my knowledge. Warraich et al 3 concluded that the data do not support that PC consultation is occurring earlier over time but rather that referrals are made late in the illness trajectory. While this may be accurate based on functional status, functional status is only 1 marker of illness trajectory.…”

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confidence: 99%

“…Compared with other health care professionals, Warraich et al 3 found that cardiologists made few of the referrals to PC (12.4% of total referrals), and the proportion decreased through time. While the changes in this and other referral patterns (and, perhaps, patient characteristics) could be explained in part by the rapidly increasing registry membership during the study, the low proportion of referrals is concerning.…”

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confidence: 99%

“…Outcomes of importance to patients and caregivers should ideally be integrated into the electronic health record so that they can be measured and tracked. The PC registry that served as the basis of the study by Warraich et al3 is an example of such integration. Roles, capacities, and competencies vary depending on the health system, clinicians, and resources available.…”

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Improving Primary and Specialist Palliative Care in Cardiovascular Disease

Bekelman

2019

JAMA Netw Open

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Palliative care (PC) focuses on improving quality of life for people with severe illness of any age. Palliative care can be provided by a multidisciplinary team of PC specialists or by other health care professionals as primary or basic PC. Palliative care can be provided concurrent with life-prolonging or curative care as needed from time of diagnosis. In contrast, hospice (as defined in the United States) is a form of PC focused on providing comfort to people with an estimated prognosis of 6 months or less. Two 2017 systematic reviews 1,2 present early evidence of the benefit of PC in cardiovascular disease (CVD), particularly for patients with heart failure. Warraich et al 3 conducted a retrospective study using a PC registry to understand changes in characteristics and trends among 1801 patients with CVD referred to PC specialists during a 3-year period, from 2015 through 2017. The main question was whether patients with CVD were seen earlier in the disease trajectory over time, measured using the palliative performance score, a health care professional-rated measure of functional status. Warraich et al 3 found that 28.9% of patients (521 of 1801) had low palliative performance scores, consistent with being bedbound and requiring total care. This percentage did not change through time. Patients reported moderate to severe symptoms, including poor well-being, tiredness, anorexia, dyspnea, and pain. The study identified some changes from 2015 to 2017, including a reduced proportion of black patients (11.9% in 2015 vs 6.3% in 2017), an increased proportion of coronary artery disease and valvular heart disease diagnoses (25.6% in 2015 vs 30.1% in 2017), and a reduced proportion of referrals from cardiologists (16.5% in 2015 vs

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“…JAMA Network Open has previously published studies on this topic, including comparisons of care at hospitals serving minority vs nonminority patients, 8 approaches to making decisions about life support, 9 physician orders for lifesustaining treatment, 10 and trends in the use of palliative care for patients with cardiovascular disease. 11 We are interested in reports of original research that present novel ideas to address this difficult problem. Because of the complexity of the problem and the interprofessional nature of potential solutions, appropriate studies might rely on a variety of methods and disciplines.…”

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Understanding and Improving Palliative Care and Care Near the End of Life

2019

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Characteristics and Trends Among Patients With Cardiovascular Disease Referred to Palliative Care

Abstract: IMPORTANCE Use of palliative care (PC) for patients with cardiovascular disease (CVD) has increased recently. However, it is unknown if patients are receiving earlier referrals to PC. OBJECTIVE To assess characteristics and trends of patients with CVD referred to PC.

Cited by 53 publications

References 30 publications

Knowledge, attitude, confidence, and educational needs of palliative care in nurses caring for non-cancer patients: a cross-sectional, descriptive study

Knowledge, attitude, confidence, and educational needs of palliative care in nurses caring for non-cancer patients: a cross-sectional, descriptive study

Improving Primary and Specialist Palliative Care in Cardiovascular Disease

Understanding and Improving Palliative Care and Care Near the End of Life

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