"Not the 'grim reaper service'": an assessment of provider knowledge, attitudes, and perceptions regarding palliative care referral barriers in heart failure.
"Not the 'grim reaper service'": an assessment of provider knowledge, attitudes, and perceptions regarding palliative care referral barriers in heart failure.
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DOI：
10.1161/jaha.113.000544
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发表时间：
2014-01-02
影响因子：
5.4
通讯作者：
Weinberger M
中科院分区：
文献类型：
--
作者：
Kavalieratos D;Mitchell EM;Carey TS;Dev S;Biddle AK;Reeve BB;Abernethy AP;Weinberger M
尽管在症状负担和预后方面与癌症患者相似，但心力衰竭 (HF) 患者接受姑息治疗的频率往往要低得多。我们试图探索心脏病学、初级保健和姑息治疗提供者认为阻碍心力衰竭患者姑息治疗转诊的因素。我们针对以下方面进行了半结构化访谈：(1) 晚期心力衰竭患者的感知需求； (2) 专业姑息治疗的知识、态度和经验； (3) 心力衰竭姑息治疗转诊的感知指征和最佳时机； (4) 姑息治疗转诊的障碍。两名研究人员使用模板分析（一种定性技术）分析数据。我们采访了来自 3 个专业的 18 名医生、护士和助理医生：心脏病学、初级保健和姑息治疗。提供者对于什么是姑息治疗以及它如何补充传统心力衰竭治疗以减少心力衰竭相关痛苦的了解有限。访谈发现了几个潜在的障碍：心力衰竭的不可预测的过程；整个 HF 轨迹缺乏明确的转诊触发点；标准心力衰竭治疗与姑息治疗的区别也存在模糊性。尽管如此，提供者表示有兴趣将姑息治疗纳入传统的心衰护理，但不确定如何启动合作。由于提供者知识有限以及对姑息治疗作为为濒临死亡者保留的服务的误解，心力衰竭患者的姑息治疗转诊可能不是最佳的。这些因素代表了提供者教育的潜在可修改目标，这可能有助于改善对未解决疾病相关负担的心力衰竭患者的姑息治疗转诊。
Although similar to cancer patients regarding symptom burden and prognosis, patients with heart failure (HF) tend to receive palliative care far less frequently. We sought to explore factors perceived by cardiology, primary care, and palliative care providers to impede palliative care referral for HF patients. We conducted semistructured interviews regarding (1) perceived needs of patients with advanced HF; (2) knowledge, attitudes, and experiences with specialist palliative care; (3) perceived indications for and optimal timing of palliative care referral in HF; and (4) perceived barriers to palliative care referral. Two investigators analyzed data using template analysis, a qualitative technique. We interviewed 18 physician, nurse practitioner, and physician assistant providers from 3 specialties: cardiology, primary care, and palliative care. Providers had limited knowledge regarding what palliative care is, and how it can complement traditional HF therapy to decrease HF‐related suffering. Interviews identified several potential barriers: the unpredictable course of HF; lack of clear referral triggers across the HF trajectory; and ambiguity regarding what differentiates standard HF therapy from palliative care. Nevertheless, providers expressed interest for integrating palliative care into traditional HF care, but were unsure of how to initiate collaboration. Palliative care referral for HF patients may be suboptimal due to limited provider knowledge and misperceptions of palliative care as a service reserved for those near death. These factors represent potentially modifiable targets for provider education, which may help to improve palliative care referral for HF patients with unresolved disease‐related burden.