Palliative care for patients with heart failure: facilitators and barriers - a cross sectional survey of German health care professionals

Abstract

BackgroundCompared to patients with cancer, heart failure patients are seldom candidates for palliative care. Numerous studies have investigated reasons why heart failure patients do not receive palliative care; however, none of these studies have ever evaluated the situation in the German health care setting. This study aims to identify German healthcare providers’ (HCP) perception of barriers and facilitators to palliative care of patients with chronic heart failure.MethodsWe conducted an online-survey with 315 nurses and physicians of different medical disciplines.ResultsEven though heart failure patients’ need of palliative care and its advantages has been recognized, HCP see potential for development and improvement. A lack of knowledge about the content and measures of palliative care, poor communication and unclear responsibilities between medical disciplines, difficulties to determine the right time to initiate palliative care, and the feeling not to be prepared to discuss end-of-life issues with the patient has been identified as barriers. Further, HCP believe that patients and relatives do not possess adequate knowledge about the disease and its progression and are therefore unprepared in asking questions regarding palliative care. They rather tend to demand everything possible to be done in order prolong life, and are reluctant to accept that life is limited. Overall, HCP perceive that dying is a taboo subject within our society placing palliative care on the same level as assisted dying. In addition, results indicate that HCP have an inappropriate notion of ideal medicine fearing to lose patient and are worried about the appropriateness of PC remuneration.ConclusionsIn order to overcome the described barriers, HCP, patients, and relatives need to be educated in palliative care. Information and education encompassing the aim, content and measures of palliative care needs to be provided for all parties in order to optimize patient care, to foster communication between healthcare professionals, patients, and relatives, and to overcome perceived barriers.Trial registrationDRKS00007119Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1609-x) contains supplementary material, which is available to authorized users.

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

“…In contrast, the request for palliative care by the patient, relatives or the cardiology team was indicated rarely (5% each). This is in correspondence to previous studies demonstrating that cardiologists and their patients restrict palliative care to end-of-life care and have no specific ideas about integrating palliative care in earlier phases of the disease trajectories [15,16,20].…”

“…Various studies analyzed potential barriers responsible for this almost lacking integration of palliative care in patients with advanced cardiologic diseases [2,[15][16][17][18][19]. Potential reasons may be that the estimation of prognosis and trajectory of disease is considered more difficult than in cancer patients [2,17,18].…”

“…In contrast to oncology clinics, there are usually no established interactions, cooperation or communication structures between cardiology and palliative care specialists [2,15,19]. A limited understanding of the other specialist discipline hampers a professional collaborative approach to the specific patients` needs [15][16][17]. In the context of cardiologic diseases, palliative care is usually considered to be restricted to end-of-life care and cardiologists, but also the patients themselves and their family caregivers usually have no or only little knowledge about the potential benefits of palliative care in chronic heart failure patients [15,16,20].…”

“…A limited understanding of the other specialist discipline hampers a professional collaborative approach to the specific patients` needs [15][16][17]. In the context of cardiologic diseases, palliative care is usually considered to be restricted to end-of-life care and cardiologists, but also the patients themselves and their family caregivers usually have no or only little knowledge about the potential benefits of palliative care in chronic heart failure patients [15,16,20]. The most crucial reason seems to be the absence of criteria or trigger points defining the optimal time frame to initiate palliative care [2,16,17].…”

“…In the context of cardiologic diseases, palliative care is usually considered to be restricted to end-of-life care and cardiologists, but also the patients themselves and their family caregivers usually have no or only little knowledge about the potential benefits of palliative care in chronic heart failure patients [15,16,20]. The most crucial reason seems to be the absence of criteria or trigger points defining the optimal time frame to initiate palliative care [2,16,17]. Until today, preliminary approaches using screening instruments for palliative care need in patients with chronic heart failure could not be established in daily practice [14,[21][22][23].…”