Background: Congestive heart failure is an increasingly prevalent terminal illness in a globally aging population. Prognosis for this disease remains poor despite optimal therapy. Evidence suggests that a palliative care approach may be beneficial - and is currently recommended - in advanced congestive heart failure but these services remain underutilized.
Objectives: To identify the main challenges to the access and delivery of palliative care in patients with advanced congestive heart failure, and to summarize recommendations for clinical practice based on the available literature.
Methods: MEDLINE and EMBASE were searched for articles published from 1995-2017 pertaining to end of life care in individuals suffering from CHF. Only four randomized controlled trials were found.
Results: We identified ten key challenges to access and delivery of palliative care services in this patient population: (1) Prognostic uncertainty, (2) Provider education/training, (3) Ambiguity surrounding coordination of care, (4) Timing of palliative care referral, (5) Inadequate community supports, (6) Difficulty communicating uncertainty, (7) Fear of taking away hope, (8) Insufficient advance care planning, (9) Inadequate understanding of illness, and (10) Discrepant patient/family care goals. Provider and patient education, early discussion about prognosis, and a multidisciplinary team-based approach are recommended as we move towards a model where symptom palliation exists concurrently with active disease-modifying therapies.
Conclusion: Despite evidence that palliative care may improve symptom control and quality of life in patients with advanced congestive heart failure, a multitude of current challenges hinder access to these services. Education, early discussion of prognosis and advance care planning, and multidisciplinary team-based care may be a helpful initial approach as further targeted work addresses these challenges.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6088451 | PMC |
| http://dx.doi.org/10.2174/1573403X14666180123165203 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Addressing Inadequate Documentation of Unilateral Do-Not-Resuscitate Orders.
JAMA
January 2025
Department of Pulmonary and Critical Care, University of Chicago, Chicago, Illinois.
Accuracy of Continuous Glucose Monitoring in Adults with Type 1 Diabetes Admitted to Hospital: A Real-World Multicenter Observational Study.
Diabetes Technol Ther
January 2025
Department of Diabetes & Endocrinology, The Royal Melbourne Hospital, Parkville, Australia.
Continuous glucose monitoring (CGM) use in people with type 1 diabetes (T1D) is revolutionizing management. Use of CGM in hospital is poised to transform care, however routine use is not currently recommended due to lack of accuracy validation in acute care, including in people with T1D. We aimed to determine real-world CGM accuracy in hospitalized adults with T1D.
View Article and Find Full Text PDFEarly integration of palliative care benefits both people with advanced cancer and their family caregivers, yet research on holistic end-of-life care and advance care planning remains limited. The primary objective of this study was to examine the effect of a peaceful end-of-life care program on perceived good death outcomes in people with advanced cancer and their family caregivers. Secondary objectives included exploring the program's effect on the quality relationship and end-of-life care knowledge among family caregivers.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!