Integrating palliative care and heart failure: a protocol for a realist synthesis (PalliatHeartSynthesis)

McConnell, Tracey; Burden, John; Duddy, Claire; Hill, Loreena; Howie, Clare; Jones, Bob F.; Ruane, Bob; Wong, Geoff; Reid, Joanne

doi:10.1136/bmjopen-2021-058848

Cited by 9 publications

(25 citation statements)

References 32 publications

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“…The identifying role of the need for palliative care of the NECPAL CCOMS-ICO© instrument, the protective effect of drugs against mortality, and the importance of CKD as a comorbidity to control exhaustively because it increases mortality in people with HF are also confirmed in the studied population [ 46 , 47 , 48 , 49 ]. Thus, the identification and proper management of patients with CKD and the optimization of the pharmacological treatment of HF continue to appear as aspects to be highlighted in managing HF in our population to achieve better results, as recommended in the management guides for this pathology [ 1 , 5 , 50 , 51 , 52 ].…”

Section: Discussionmentioning

confidence: 99%

Palliative Care Needs and Clinical Features Related to Short-Term Mortality in Patients Enrolled in a Heart Failure Unit

et al. 2022

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(1) Background: Heart failure (HF) is a chronic and complex pathology requiring continuous patient management due to clinical instability, associated comorbidity, and extensive pharmacological treatment. Its unpredictable course makes the advanced stages challenging to recognize and raises the need for palliative care. This study aims to identify palliative care needs in HF patients and describe clinical features related to short-term mortality. (2) Methods: A descriptive, observational, cross-sectional, and retrospective study was carried out in an HF unit of a Spanish tertiary hospital. Patients’ socio-demographic and clinical data were collected from clinical records, and different instruments were used to establish mortality risks and patients’ needs for palliative care. Subsequently, univariate and bivariate descriptive analyses were performed. A binary logistic regression model helped to determine variables that could influence mortality 12 months after admission to the Unit. (3) Results: The studied population, sixty-five percent women, had an average age of 83.27 years. Among other clinical characteristics predominated preserved ejection fraction (pEF) and dyspnea NYHA (New York Heart Association) class II. The most prevalent comorbidities were hypertension and coronary heart disease. Forty-nine percent had a low–intermediate mortality risk in the following year, according to the PROFUND index. The NECPAL CCOMS-ICO© instrument identified subjects who meet the criteria for palliative care. This predictive model identified NECPAL CCOMS-ICO© results, using beta-blockers (BB) or AIIRA (Angiotensin II receptor antagonists) and low glomerular filtration rate (GFR) as explanatory variables of patients’ mortality in the following year. (4) Conclusions: The analysis of the characteristics of the population with HF allows us to identify patients in need of palliative care. The NECPAL CCOMS-ICO© instrument and the PROFUND have helped identify the characteristics of people with HF who would benefit from palliative management.

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Section: Discussionmentioning

confidence: 99%

Palliative Care Needs and Clinical Features Related to Short-Term Mortality in Patients Enrolled in a Heart Failure Unit

et al. 2022

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“…Within step 1, the informal searches conducted differ from the more formal searching that will be carried out in step 2 as the rationale is to swiftly identify the kinds of theory that may be relevant. Once such theories are identified, we will develop an initial programme theory to test in the synthesis 21…”

Section: Methodsmentioning

confidence: 99%

“…The search strategy will be informed by our informal scoping searches, search terms in published reviews and expertise from within the project team. Any document that is likely to provide conceptually rich data, including grey literature, will be considered for inclusion in the synthesis 21…”

Section: Methodsmentioning

confidence: 99%

Integrated palliative care in oncology: a protocol for a realist synthesis

Reid,

Banks,

Blair

et al. 2024

BMJ Open

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IntroductionEmerging evidence suggests improved quality of life, reduced symptom burden and lower health services costs when integrated palliative care and cancer care are implemented. Integrated palliative care aims to achieve care continuity by integrating organisational, administrative and clinical services involved in patient care networks. However, integrated palliative care for cancer is not common practice. This project, therefore, aims to understand how integrated palliative care and cancer care works in different healthcare settings (inpatient/outpatient), and for which groups of people (at what stage of the cancer journey), so we can develop guidance for optimal delivery.Methods and analysisWe will conduct a realist synthesis to develop a programme theory of how integrated palliative care in cancer works, for whom and in what contexts to achieve improved symptom management and quality of life for patients and their families.This realist synthesis will follow the five stages outlined by Pawson: (1) locating existing theories, (2) searching for evidence, (3) article selection, (4) extracting and organising data and (5) synthesising the evidence and drawing conclusions. We will work closely with our expert stakeholder group, which includes health and social care professionals providing palliative care and oncology; management and policy groups and members of the public and patients. We will adhere to RAMESES quality standards for undertaking a realist synthesis.Ethics and disseminationEthics approval for this project is not required.The realist synthesis will develop a programme theory that provides clarity on the optimal delivery of palliative care for adults with cancer. We will use the programme theory to coproduce guidance and user-friendly outputs, working with stakeholders to inform delivery of best practice. Findings will inform further research in integrated palliative care and cancer. Stakeholder engagement will assist in the dissemination of our findings.PROSPERO registration numberCRD42023389791.

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“…In order to ensure standardized provision of high-quality palliative care for patients with HF, guidelines could provide more specific language on how exactly palliative care should be provided -else guideline recommendations remain elusive. In particular, there are four major questions which should be answered explicitly when discussing the provision of palliative care for patients with HF: 11,12,14,[16][17]26 Thus, the complexities of palliative care provision have to be addressed first and foremost in clinical research and evidence synthesis, 27 in order to shape a nuanced evidence base which in turn can inform more precise guideline recommendations. In addition, more international efforts to develop standardized definitions and quality criteria for palliative care provision for patients with HF are warranted.…”

Section: Addressing the Complexities Of Palliative Care Provisionmentioning

confidence: 99%

“…In randomized controlled trials, palliative care has been provided in a myriad of different ways, with varying providers targeting heterogeneous HF populations with different combinations of interventions in various healthcare settings 11,12,14,16–17,26 . Thus, the complexities of palliative care provision have to be addressed first and foremost in clinical research and evidence synthesis, 27 in order to shape a nuanced evidence base which in turn can inform more precise guideline recommendations. In addition, more international efforts to develop standardized definitions and quality criteria for palliative care provision for patients with HF are warranted.…”

Section: Directions For the Futurementioning

confidence: 99%

Palliative care in heart failure guidelines: A comparison of the 2021 ESC and the 2022 AHA/ACC/HFSA guidelines on heart failure

Blum

Goldstein

Jaarsma

et al. 2023

European J of Heart Fail

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The role of palliative care for patients with heart failure (HF) is discussed in both most recent HF guidelines, the 2021 ESC guideline and the 2022 AHA/ACC/HFSA guideline. This review compares the definitions, concepts and specific recommendations regarding palliative care for patients with HF in these two guidelines. Both HF guidelines define palliative care as a multidisciplinary approach aimed at alleviating physical, psychological and spiritual distress of patients and caregivers. Both agree emphatically on the importance of palliative care across all stages of HF with integration early in the illness trajectory. Also, the guidelines concur that palliative care should include symptom management, communication about prognosis and life‐sustaining therapies, as well as advance care planning. Despite this consensus, only the AHA/ACC/HFSA guideline gives official recommendations on the provision of palliative care. Moreover, the AHA/ACC/HFSA guideline advocates for a needs‐based approach to palliative care allocation while the ESC guideline ties palliative care closely to advanced HF and end‐of‐life care. The ESC guideline highlights the need for regular symptom assessment and provides detailed guidance on symptom management. The AHA/ACC/HFSA guideline elaborates further on shared decision‐making, caregiver and bereavement support, as well as hospice care, and distinguishes between primary palliative care (provided by all clinicians) and secondary (specialty‐level) palliative care. Although there is strong agreement on the importance and components of palliative care for patients with HF, there are nuanced differences between the two HF guidelines. Most notably, only the AHA/ACC/HFSA guideline issues recommendations for the provision of palliative care.

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Integrating palliative care and heart failure: a protocol for a realist synthesis (PalliatHeartSynthesis)

Cited by 9 publications

References 32 publications

Palliative Care Needs and Clinical Features Related to Short-Term Mortality in Patients Enrolled in a Heart Failure Unit

Palliative Care Needs and Clinical Features Related to Short-Term Mortality in Patients Enrolled in a Heart Failure Unit

Integrated palliative care in oncology: a protocol for a realist synthesis

Palliative care in heart failure guidelines: A comparison of the 2021 ESC and the 2022 AHA/ACC/HFSA guidelines on heart failure

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