Improving end-of-life care for patients with chronic heart failure: "Let's hope it'll get better, when I know in my heart of hearts it won't"
Improving end-of-life care for patients with chronic heart failure: "Let's hope it'll get better, when I know in my heart of hearts it won't"
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DOI：
10.1136/hrt.2006.106518
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发表时间：
2007-08-01
期刊：
影响因子：
5.7
通讯作者：
Higginson, Irene J.
中科院分区：
文献类型：
--
作者：
Selman, Lucy;Harding, Richard;Higginson, Irene J.
背景资料：慢性心力衰竭（chronic heart failure，CHF）死亡率高、症状负担重，临床指南规定了姑息治疗干预措施，但缺乏证据指导临床实践，目的：（1）制定改善CHF临终关怀的指南和建议;（2）生成关于患者和护理者对未来治疗方式的偏好的数据，并调查工作人员、患者和护理者之间关于生命结束问题的沟通。设计：对20例CHF患者进行了半结构式定性访谈（纽约心脏协会功能分级III - IV），11名家庭护理人员，6名姑息治疗临床医生和6名心脏病学临床医生。设置：英国伦敦的一家三级医院。结果：患者和家属报告了广泛的临终关怀偏好。没有人与他们的临床医生讨论过这些问题，也没有人知道未来护理模式的选择或替代方案，例如采用姑息治疗方法。患者和护理人员生活在恐惧和焦虑中，并且不了解他们诊断的影响。心脏科工作人员证实，他们很少向患者提出此类问题。疾病和专业的具体障碍，以改善临终关怀determined.Conclusions：新的，综合数据提供了三个建议，以改善护理符合政策指示：敏感的信息和讨论的临终问题与病人和家属;相互教育的心脏病学和姑息治疗的工作人员;以及双方同意的CHF患者姑息治疗转诊标准和护理途径。
Background: Although chronic heart failure (CHF) has a high mortality rate and symptom burden, and clinical guidance stipulates palliative care intervention, there is a lack of evidence to guide clinical practice for patients approaching the end of life.Aims: (1) To formulate guidance and recommendations for improving end- of- life care in CHF; (2) to generate data on patients' and carers' preferences regarding future treatment modalities, and to investigate communication between staff, patients and carers on end-of-life issues.Design: Semistructured qualitative interviews were conducted with 20 patients with CHF (New York Heart Association functional classification III - IV), 11 family carers, 6 palliative care clinicians and 6 cardiology clinicians.Setting: A tertiary hospital in London, UK.Results: Patients and families reported a wide range of end-of-life care preferences. None had discussed these with their clinicians, and none was aware of choices or alternatives in future care modalities, such as adopting a palliative approach. Patients and carers live with fear and anxiety, and are uninformed about the implications of their diagnosis. Cardiac staff confirmed that they rarely raise such issues with patients. Disease- and specialism-specific barriers to improving end-of-life care were identified.Conclusions: The novel, integrated data presented here provide three recommendations for improving care in line with policy directives: sensitive provision of information and discussion of end-of-life issues with patients and families; mutual education of cardiology and palliative care staff; and mutually agreed palliative care referral criteria and care pathways for patients with CHF.