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

Abstract

BackgroundCurrent models of end-of-life care (EOLC) have been largely developed for cancer and may not meet the needs of heart failure patients. AimTo review the literature concerning conversations about EOLC between patients with heart failure and healthcare professionals, with respect to the prevalence of conversations; patients' and practitioners' preferences for their timing and content; and the facilitators and blockers to conversations.

Care and communication between health professionals and patients affected by severe or chronic illness in community care settings: a qualitative study of care at the end of life

“…There is evidence that many professionals lack confidence in undertaking ACP and tend to avoid such discussions. 13,14,35,53,67,87,88 Several studies suggest that, as there is uncertainty about which professional should undertake discussion of ACP, there is a tendency, particularly among GPs, to defer responsibility to someone else. 9,12,53,64,67,89 Evidence also suggests that, although patients tend to expect professionals to take the initiative, there is a tendency for professionals to wait for patients to open the discussion.…”

“…104,112 Vague and indeterminate language, allusion and euphemism are employed by professionals as well as patients. 12,67,93,104,112,113 Reluctance to destroy hope is a common reason for professionals to avoid end of life discussions, 12,88,92 and there is evidence that patients strive to balance understanding of their situation with the maintenance of hope. 95,114 Nevertheless, the outcome of interaction that is based on implicit communication and tacit understanding is likely to be misinterpretation and misunderstanding.…”

“…101,[109][110][111] Many studies describe the caution and circumspection that professionals employ when seeking cues about patient receptivity to ACP. 67,87,88 Open questions may be used as opportunities, or 'offers', which patients may elect to take up or ignore, and the use of 'hypothetical' questions and scenarios may soften the impact of confronting difficult issues directly. 104,112 Vague and indeterminate language, allusion and euphemism are employed by professionals as well as patients.…”

“…It is evident that patients vary greatly in their receptiveness to ACP discussions and the point in time, if any, at which they are ready to engage with them. 5,12,67,78,88,92,106,[122][123][124] Several studies report a preference among some patients to focus on living in the present, rather than thinking or talking about dying. This can be regarded as a positive means for maintaining a sense of personal integrity and engagement with life, rather than a negative strategy of 'denial'.…”

“…However, a growing body of qualitative evidence gives an indication of the great complexity, ambivalence and variability of patients' desire to engage in ACP, and their responses to professional invitations to do so. 12,25,67,69,81,88,94,98,122 BACKGROUND NIHR Journals Library www.journalslibrary.nihr.ac.uk…”