Qualitative study to explore what patients with heart failure find significant during integrated palliative care sessions in a Danish clinic

Abstract

ObjectiveIn the field of palliative care (PC) as it is integrated into heart failure (HF) treatment, it is essential to explore the patient experience and build on this knowledge for the further development of PC practice and policy. Based on an intervention study, this paper explores what patients with HF find significant in integrated sessions using a narrative S’ approach.DesignWe conducted a semistructured interview study with a qualitative analysis focused on meaning making. The study follows the guidelines of Consolidated Criteria for Reporting Qualitative Research.Participants and settingThe inclusion criteria for the PC intervention were (1) a new diagnosis of HF, (2) follow-up treatment at this local Danish HF clinic and (3) informed consent to participate in the integrated PC intervention. The only exclusion criterion was if the patient was already engaged in a PC programme. 20 patients agreed to participate in the intervention, and 12 of these completed the S’ approach sessions and participated in this interview study.ResultsOverall, the analysis showed that the integrated S’ approach sessions were successful in joining an embodied patient perspective with a medical perspective. The thematic analysis resulted in three themes supporting the overall findings: sessions bring comfort, telling your story provides a sense of meaningfulness, and integrating perspectives of HF into everyday life.ConclusionThe method using the S’ approach in integrated PC and HF sessions was significant in various ways. First, patients experienced a calm and safe atmosphere and perceived that the nurse was truly interested in them. Second, the integrated sessions based on the S’ approach were able to bring comfort to lived physical, psychosocial and existential issues. Last, it allowed patients to combine their embodied understanding of HF with a medical perspective, thereby finding meaning in the sense of how everything is connected.

Use of narrative methods in rehabilitation and palliative care in Scandinavian countries: A scoping review

“…We found 11 peer‐reviewed papers through snowballing [21–29]. In all, we included 42 records in this scoping review [17–58].…”

“…All studies share a more or less explicit presupposition that the objective of using narrative methods is to spark reflection, facilitate meaning, strengthen identity and foster an understanding of what it means to live with an illness. Studies that are explicit about the objective of strengthening ‘personal meaning’ and ‘dignity’ in life apply dignity therapy [19,42,54], whereas Socratic dialogue [45,46], therapeutic support group [55], creative writing [20,24,40] and the S’ approach [29] focus on ‘insight’ and ‘understanding’ of life with an LTI.…”

“…Another core principle is the use of a procedural manual to guide and structure the narrative. However, the manual differs from a set of specific questions in recap [18] to an outline on dimension in, for example, the S’ approach [29]. In the therapeutic support group , the facilitator asks children to bring pictures from home and to create a painting using water colours [55].…”

“…Seventeen papers [18,19,22,24,28–30,32,36,37,39,44,45,49,50,53,55] are concerned with revealing a meaningful outcome of the practice or method described. In these cases, the outcome refers to the significance for the users involved, but this is explored and described in various ways, from specific description of the research design and methods [24] to a more subtle dissemination [22].…”

“…We found two PhD theses [17,18] and two reports [19,20] through a grey literature search. We found 11 peer‐reviewed papers through snowballing [21–29]. In all, we included 42 records in this scoping review [17–58].…”