End-of-Life Care Preferences of Patients Enrolled in Cardiovascular Rehabilitation Programs

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

“…Two (from the same study) found no patients had discussed their EOLC preferences, disease progression, or future care options with healthcare professionals: 55,56 nine papers reported that few patients had discussed prognosis, 51,52,67,74 EOLC, 52,53,54,69 cardiopulmonary resuscitation or other life-sustaining interventions, 49,69,71 or plans for future care. 53,71,74 A uniform picture emerges that the great majority of patients with heart failure do not perceive that they have had a discussion with their healthcare professionals concerning the end of life.…”

“…They desire more information concerning prognosis, 55,60,63,67,71,74 resuscitation, 67 and how their condition is likely to progress, 49,60,71 as this allows them to put their affairs in order and make plans for their families. 63,66,74 An opportunity to discuss their fears about the future is reassuring; 60,71 for some the knowledge that death could be sudden is welcomed, as this is their preferred mode of death. 52 Others do not wish to have these conversations.…”

“…54 They accept a low level of knowledge about their illness and do not view themselves as capable of understanding it, preferring to leave medical issues to their professionals. 50 Some explicitly do not want prognostic information, 52 and avoid the subject when raised by doctors, 51 preferring to enjoy the present without conversations that will cause worry to themselves 50,52 or their families, 52,65 and a loss of hope 50,53,66,71 Others have mixed and ambivalent views, having some awareness but not wishing to openly acknowledge their poor prognosis. [65][66][67] When conversations are desired, patients want these to be held sensitively, 50,55 with honesty, 55,63,65,67 and repeated opportunities to talk.…”

Palliative Care and Cardiovascular Disease and Stroke: A Policy Statement From the American Heart Association/American Stroke Association

“…105 A study of patients enrolled in cardiac rehabilitation programs revealed that 96% of patients expressed interest in discussing advance care planning with their physicians, but only 15% had discussed advanced planning with their physicians and 10% had confidence that their physicians understood their end-of-life wishes. 107 Patients should be advised to designate a healthcare agent through the completion of a healthcare proxy (or a durable power of attorney for health care). Healthcare proxy execution requirements vary from state to state.…”

Reflexiones sobre el testamento vital (I)

“…En un 66% de los casos fue el paciente quien comenzó la conversación, en el 29% la familia y sólo en un 5% el médico. Además, el 90% de los pacientes afirmaba que su médico no entendía sus deseos de cara al final de la vida 49 . Estos datos confirman lo que ya había puesto en evidencia el estudio SUPPORT 50 : la muerte en los hospitales es una experiencia demasiado insatisfactoria y ocurre rodeada de fallos en la comunicación médico-paciente, con una alta frecuencia de tratamientos agresivos y otras características de la muerte hospitalaria que dificultan que pueda ser entendida como una «buena muerte».…”