GPs and nurses in primary care want to overcome barriers to discussion about end of life care with their heart failure patients, according to new research from Dr Markus Schichtel and team, but they need specific interventions to make this possible.
The research explored the process of discussion, called advance care planning, or ACP, amongst primary care healthcare staff with patients who have heart failure. Interventions such as question prompts, shared decision-making approaches, synchronising ACP across medical specialities, and disease specific training were recommended by the healthcare staff in this study.
ACP does not take place for most heart failure patients, although it’s known to improve palliative care. Only 7% of heart failure patients had their palliative care needs recognized, compared with 50% of cancer patients, so ACP is widely advocated.
This study is based on 24 in-depth interviews with GPs and primary care nurses. The interviews revealed widespread recognition of the benefits of ACP which was described as synonymous with providing holistic care and improving patients’ quality of life in heart failure. However, some interviewees feared that initiating ACP could irrevocably damage their doctor-patient relationship. Their own fear of death and dying, a lack of disease specific communication skills and uncertainty about the right timing were also significant barriers to ACP.
To optimise their engagement with ACP with heart failure patients, primary care healthcare professionals recommended better clinician-patient dialogue through question prompts, enhanced shared decision-making approaches, synchronising ACP across medical specialities, and disease specific training.
Read this research
M Schichtel, J MacArtney, B Wee, A-M Boylan: Implementing advance care planning in heart failure: A qualitative study of primary healthcare professionals, in BJGP, 5 May 2021
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