Palliative Care Consultations for Heart Failure Patients: How Many, When, and Why?

Bakitas, Marie; MacMartin, Meredith A.; Trzepkowski, Kenneth; Robert, Alina M.; Jackson, Lisa R.; Brown, Jeremiah R.; Dionne‐Odom, J. Nicholas; Kono, Alan T.

doi:10.1016/j.cardfail.2013.01.011

Cited by 116 publications

(87 citation statements)

References 56 publications

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“…31,32,[36][37][38] The negative effects of ethical conflicts are widespread for patients, patients' families, and health care providers. Quality care and patient safety are threatened when health care providers are burdened by stressful ethical conflicts that erode interpersonal trust, compromise working relationships, and fragment care.…”

Section: Study Procedures and Data Collectionmentioning

confidence: 99%

“…Similarly, Morden et al 31 reported that Medicare recipients with cancer received aggressive treatments, such as ventilator support, relative to their poor prognosis in the last weeks of life. Bakitas et al 32 also reported that heart failure patients are not often referred for palliative care services until the last month of life and suggested that advance care planning is often delayed.…”

Section: Introductionmentioning

confidence: 99%

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Screening Situations for Risk of Ethical Conflicts: A Pilot Study

Pavlish¹,

Hellyer²,

Brown-Saltzman³

et al. 2015

American Journal of Critical Care

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A closed-book, multiple-choice examination following this article tests your under standing of the following objectives:1. Describe the impact of ethical conflict in the intensive care unit (ICU) for patients, families, and health care workers. 2. Describe risk factors and early warning signs of potential ethical conflicts with ICU patients. 3. Explain key results of ethical risk factor screening for critical care nurses. Results Older patients with multiple comorbid conditions and aggressive treatments were frequently assessed to be at risk for ethical conflicts. Nurses who witnessed patients' suffering and deterioration were likely to initiate the screening process. The most prominent family risk factors included unrealistic expectations and adamancy about treatment. The most prominent early indicators were signs of patients' suffering, unrealistic expectations, and providers' own moral distress. High-risk situations averaged a greater number of risk factors and early indicators than did medium-and low-risk situations. Certain risk factors featured prominently in high-risk situations. Conclusions A phenomenon of shared suffering emerged from the study and signifies the importance of relational strategies such as routine family conferences and ethics consultation.

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Section: Study Procedures and Data Collectionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Screening Situations for Risk of Ethical Conflicts: A Pilot Study

Pavlish¹,

Hellyer²,

Brown-Saltzman³

et al. 2015

American Journal of Critical Care

View full text Add to dashboard Cite

show abstract

“…13,27,87,102,[106][107][108] However, patients and caregivers with heart failure access palliative services far less often than patients with cancer. 105,109 Even in cases when patients with heart failure are referred for palliative care, consultations are initiated only very late in the care trajectory. 109 Although not synonymous, end-of-life care and palliative care overlap in many ways.…”

Section: May 8 2018mentioning

confidence: 99%

“…105,109 Even in cases when patients with heart failure are referred for palliative care, consultations are initiated only very late in the care trajectory. 109 Although not synonymous, end-of-life care and palliative care overlap in many ways. A recent study of older adults' caregivers at the end of life examined 900 000 community-dwelling Medicare beneficiaries who received support from 2.3 million caregivers.…”

Section: May 8 2018mentioning

confidence: 99%

Projected Costs of Informal Caregiving for Cardiovascular Disease: 2015 to 2035: A Policy Statement From the American Heart Association

Dunbar¹,

Khavjou²,

Bakas³

et al. 2018

Circulation

198

102

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INTRODUCTION:In a recent report, the American Heart Association estimated that medical costs and productivity losses of cardiovascular disease (CVD) are expected to grow from $555 billion in 2015 to $1.1 trillion in 2035. Although the burden is significant, the estimate does not include the costs of family, informal, or unpaid caregiving provided to patients with CVD. In this analysis, we estimated projections of costs of informal caregiving attributable to CVD for 2015 to 2035. METHODS:We used data from the 2014 Health and Retirement Survey to estimate hours of informal caregiving for individuals with CVD by age/sex/race using a zero-inflated binomial model and controlling for sociodemographic factors and health conditions. Costs of informal caregiving were estimated separately for hypertension, coronary heart disease, heart failure, stroke, and other heart disease. We analyzed data from a nationally representative sample of 16 731 noninstitutionalized adults ≥54 years of age. The value of caregiving hours was monetized by the use of home health aide workers' wages. The per-person costs were multiplied by census population counts to estimate nation-level costs and to be consistent with other American Heart Association analyses of burden of CVD, and the costs were projected from 2015 through 2035, assuming that within each age/sex/racial group, CVD prevalence and caregiving hours remain constant. RESULTS:The costs of informal caregiving for patients with CVD were estimated to be $61 billion in 2015 and are projected to increase to $128 billion in 2035. Costs of informal caregiving of patients with stroke constitute more than half of the total costs of CVD informal caregiving ($31 billion in 2015 and $66 billion in 2035). By age, costs are the highest among those 65 to 79 years of age in 2015 but are expected to be surpassed by costs among those ≥80 years of age by 2035. Costs of informal caregiving for patients with CVD represent an additional 11% of medical and productivity costs attributable to CVD. CONCLUSIONS:The burden of informal caregiving for patients with CVD is significant; accounting for these costs increases total CVD costs to $616 billion in 2015 and $1.2 trillion in 2035. These estimates have important research and policy implications, and they may be used to guide policy development to reduce the burden of CVD on patients and their caregivers.

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“…Other studies report various unmet palliative care needs in patients with advanced heart failure [6,7]. Although some studies suggest beneficial effects of palliative care consultation [8][9][10][11][12], less than 10% of patients with heart failure receive palliative care today [13,14].…”

Section: Introductionmentioning

confidence: 99%

Self-assessment and Screening for Palliative Care Need in Patients with Chronic Heart Failure

Ehlert¹,

Kodolitsch²,

Ullrich³

et al. 2017

J Palliat Care Med

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Objective: Patients with chronic heart failure (CHF) rarely receive palliative care today. Methods:In a cross-sectional pilot study we evaluated feasibility of self-assessment and physician-directed screening for palliative care need in CHF patients. Patients answered German versions of the "Minimal Documentation system for patients in palliative care" (MIDOS), "Distress-Thermometer" (DT), and the "Patient Health Questionnaire" (PHQ4). A modified version of the "Five-Item Palliative Care Screening Tool" was used to screen for palliative care need by the treating cardiologists.Results: 218 patients were asked to participate and 148 (67%) completed all questionnaires. Median symptom burden (MIDOS) was 7 out of 30 points (SD 4.868), overall wellbeing was two of 5 (SD 0.902), and median distress score was 6 of 10 (SD 2.318). Most frequent moderate or severe symptoms were dyspnea (52%), weakness (51%), and tiredness (49%). Significant distress (DT score>5) was indicated by 106 patients (72%). Exhaustion (79%), sleeping problems (75%), and problems with breathing (69%) were most frequent problems. Only 11% and 14% of patients presented with significant anxiety and depression, respectively (PHQ4-score>3).Palliative care need was scored with mean 6.8 out of 12 points (SD 2.223). Using a cut-off value of >5, 113 patients (76%) would have needed palliative care. Objective parameters for palliative care need (symptom burden 43%, distress 68%, decision-making 67%) were indicated, but request for palliative care by the patients, their relatives (5%) or the cardiology team (5%) was rare. Symptom burden and palliative care screening showed significant, but not clinically relevant interaction. Conclusion:This pilot study, feasibility of palliative care self-assessment and the modified screening instrument could be demonstrated in CHF patients. For comprehensive screening, both perspectives have to be included. First results indicate significant symptom burden, psychological distress and a high need for additional palliative care in CHF patients.

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Palliative Care Consultations for Heart Failure Patients: How Many, When, and Why?

Abstract: Background-In preparation for development of a palliative care intervention for patients with heart failure (HF) and their caregivers, we aimed to characterize the HF population receiving palliative care consultations (PCCs).

Cited by 116 publications

References 56 publications

Screening Situations for Risk of Ethical Conflicts: A Pilot Study

Screening Situations for Risk of Ethical Conflicts: A Pilot Study

Projected Costs of Informal Caregiving for Cardiovascular Disease: 2015 to 2035: A Policy Statement From the American Heart Association

Self-assessment and Screening for Palliative Care Need in Patients with Chronic Heart Failure

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