Difficult conversations and chronic heart failure: do you talk the talk or walk the walk?

Abstract

When having these difficult conversations, clinicians need to assess the individual's need and wishes for information as well as their social and cultural background. They also need to consider the setting, timing and content of the discussion, as well as strategies to promote coping and adjustment. Most importantly, patients need a treatment plan to address palliative and supportive care needs to be implemented at the time of breaking this bad news, so that they and their families do not feel abandoned. Learning effective communication skills, implementing strategies for debriefing and the fostering of a team approach, may minimize burden on health providers and improve palliative and supportive care for people with heart failure.

Missed Opportunities for Advance Care Planning Communication During Outpatient Clinic Visits

“…The finding that some physicians hedged their responses to patient questions about prognosis, or denied patient expressions of emotion underscores the discomfort many providers face when discussing sensitive topics such as the possibility of decline or death. 15,39 It may be particularly difficult for providers to discuss ACP with their heart failure patients for whom the trajectory of decline is highly variable and the timing and manner of death uncertain. 40 While efforts have been made to increase physician comfort with ACP conversations through communication trainings, 33,34,38,[41][42][43][44] medical education may need to incorporate updated illness models for non-malignant chronic diseases to help foster physician awareness of the relevance of ACP for patients with heart failure.…”

“…13,14 Some of the reasoning behind these recommendations is that early communication can help patients think about, plan, and prepare for their future care. Aspects of ACP discussions include an explanation of HF trajectory and prognosis, 4,[15][16][17] an exploration and elicitation of treatment preferences and goals of care, 12,[18][19][20] and a discussion of concerns that transcend but are related to the biomedical, such as psychosocial, spiritual, and quality of life issues. 21,22 Provider attention to multiple areas of patients' concern may serve to facilitate more meaningful and productive discussions around future care.…”

Palliative care in heart failure: facts and numbers

“…Whilst their study design does not set out to produce results that are statistically generalizable, key themes have emerged: That patients often experience barriers to open communication with healthcare professionals, including an inability to talk freely with clinicians and to ask questions about prognosis, together with a sense that information is being withheld 16, 17, 18, 19. This may reflect an understandable reluctance of healthcare professionals to initiate discussion on end‐of‐life issues, either as a manifestation of their own attitudes to death or dying or anxiety about undermining patient's trust or hopes for the future 20. In addition, patients describe professionally driven healthcare services that focus on delivering guideline‐based medical treatment.…”

“…More recently Blinderman and colleagues studied a sample of 103 patients in the USA 20. The mean age was 67 years, 72% male, and all were in NYHA class III/IV.…”

End-of-life care conversations with heart failure patients: a systematic literature review and narrative synthesis

“…18,38 A balance of optimism and realism is recommended 78,79 avoiding either embracing or negating hope, but acknowledging the uncertainty. 80 Some patients may be confused by what appears to be a mixed message and find the emotional and cognitive dissonance involved difficult. 78 This review indicates that in practice many patients do not have these discussions 49,[51][52][53][54][55][56][57][58][59][60][61][62][63] despite some indicating a wish to do so 49,55,60,63,65,66 The uncertainty of prognosis 51,53,[71][72] and fear of causing patients anxiety 51,54 are major barriers.…”