Communication about Prognosis and End-of-Life in Heart Failure Care and Experiences Using a Heart Failure Question Prompt List

Abstract

Background: To further advance the use of a heart-failure-specific question prompt list (HF-QPL) for communication about prognosis and end-of-life care, knowledge about such communication and the perceptions and experiences of professionals is needed. Objectives: 1. to describe health care professionals’ perceptions of communication about prognosis and end-of-life in heart failure (HF) care, and 2. to describe their experiences of using a HF-QPL. Design: A qualitative design that analyzed material from written assignments of nurses and physicians who were using a HF-QPL while participating in a communication course. Methods: Fifteen health care professionals from different regions in the south of Sweden were included. The data were collected from course assignments on 1. their reflection on the suitable timepoint for talking about prognosis for the first time, 2. their reflection on the HF-QPL, and 3. their experiences of using the HF-QPL in clinical practice. Data were analyzed using thematic analysis. Results: Five overarching themes were identified. The first theme was awareness of professional role responsibilities that described the recognition of different responsibilities in these conversations within the HF team. The second theme described the importance of being optimally prepared, and the third that confidence and skills are required to use the HF-QPL. The fourth theme described the HF-QPL as a bridge in the communication between professionals, patients, and family members. The fifth theme identified challenges using the HF-QPL in HF care. Conclusions: Using a HF-QPL in HF care has the potential to start conversation and facilitate discussion about the HF trajectory.

Optimizing the design and implementation of question prompt lists to support person‐centred care: A scoping review

“…It would also be imperative to involve clinicians in planning QPL design and implementation to ensure that questions are clinically relevant and to optimize QPL adoption into clinical routines. One of the included studies that used a two‐round Delphi survey to assess acceptability found that most of the questions they rated were deemed acceptable by 96 patients and 26 healthcare professionals 24 . In other research studies focussed on clinical decision support systems, which represent possible disruptions to clinical routines similar to QPLs, involving clinicians in system design resulted in significant improvement in awareness and adoption of clinical practices recommended by the system 83 …”

“…• Reliable supply of QPLs or other resources 25,58 • Reminders for administrative staff to provide QPLs to patients 58 • Consultations scheduled for longer time periods 25 • Training on using QPL 24,32 • Clinicians provided with QPLs prior to the consultation 44,58 • QPL is not too long 44 • Time constraints for consultations with patients 25,32,58 • Clinician beliefs on efficacy and relevance of QPLs 76 • Difficulty remembering to use QPL 58 • Difficulty answering certain questions on QPL 25,56 • Concerns about potential negative impacts on patients 24,32,58 • Clinicians lacking knowledge relevant to QPL questions 24,32,67 • Questions on QPL suitable for health setting 32 Abbreviation: QPL, question prompt list. Due to the limited detail about how QPLs were developed in most studies, it is not clear if or how patients were involved in QPL planning.…”

“…One of the included studies that used a two-round Delphi survey to assess acceptability found that most of the questions they rated were deemed acceptable by 96 patients and 26 healthcare professionals. 24 In other research studies focussed on clinical decision support systems, which represent possible disruptions to clinical routines similar to QPLs, involving clinicians in system design resulted in significant improvement in awareness and adoption of clinical practices recommended by the system. 83 From the patient's perspective, QPLs should be made available in advance of clinical appointments to allow time to review the questions.…”

“…Enablers for patients included having sufficient time to read the QPL before appointments, 26,43,58 translation to the patient's primary language and cultural acceptability of questions 43,58 ; not too many questions or too lengthy ones, 26,31,32,48 clinical contexts involving sensitive topics 34,38,52,58 and when physicians encouraged them to ask questions on the QPL. 26,41,43 Patient-reported barriers included the time required to read the QPL, 31,58,66 being accompanied to a consultation, 28,47 if questions were addressed in some manner before QPL use, 58,69,76 not having time to discuss QPL questions or additional questions during the consultation, 66,76 feeling overwhelmed, 33,58 feeling like clinicians disliked patient questionasking, 76 clinicians not being able to answer questions or discuss topics included in the QPL 24,32,33,56,72 and QPLs not being available in a language other than English. 58 Enablers for clinicians included receiving the QPL before consultations, 44,57 reliable supply of QPLs, 25,57 training on how to use the QPL, 24,32 the QPL is not too lengthy,…”

Palliativversorgung bei Herzinsuffizienz

“…Die Möglichkeit eines Nozebo-Effekts durch die Diskussion über die Versorgung am Lebensende bleibt relevant. Die Patient*innen unterscheiden sich auch in Bezug auf den Umfang der Informationen, die sie erhalten möchten, sodass es sinnvoll sein könnte, die Gespräche darauf abzustimmen, was vonseiten der Patient*innen gewünscht wird [11]. Checklisten, die Patient*innen und ihre Angehörigen vor dem Gespräch ausfüllen, können daher hilfreich sein, das Gespräch zu leiten.…”