Access and referral to palliative care for individuals with chronic heart failure

Abstract

Background: Chronic heart failure is associated with poor survival rates and high symptom burden. Despite recommendations for palliative care to improve symptoms and quality of life for individuals with chronic heart failure, palliative care remains underutilised by individuals with chronic heart failure. Purpose: This thesis examines patient, provider and system factors influencing access and referral to palliative care for individuals with chronic heart failure. Methods: This was a mixed-methods study encompassing a survey, a meta-synthesis and qualitative semi-structured interviews. Results: Patient: The qualitative semi-structured interviews demonstrated that patients had their own expectations of what palliative care entailed, interpreting it to be impending death or care for the dying. Each patient with chronic heart failure was unique, with their own set of comorbidities and symptom needs that led to variation in palliative care referral. Provider: The survey findings revealed that the majority of healthcare professionals would refer the patient later in the illness trajectory or as the patient reaches an advanced stage of their illness. System: Access and referral to palliative care for individuals with chronic heart failure is influenced by the perception that palliative care is a limited, finite resource that would not accept referrals for individuals with chronic heart failure. Recommendations: 1. Healthcare professionals require enhanced communication skills. 2. Collaboration between primary care, cardiology and palliative care can streamline referrals and further research on needs-based tools are required. 3. Healthcare professionals would benefit from restorative clinical supervision. 4. Referral to palliative care should be based on the patient's needs and not prognosis. 5. Patient, family and community awareness of palliative care should be improved to facilitate uptake. Shifting the name to supportive care may facilitate access if based on patient need. 6. Interprofessional education between palliative care and cardiology is needed to improve palliative care access. 7. The impact of healthcare professionals' attitudes towards end of life care on palliative care referral requires further research. 8. Policy and funding models encompassing early access is required to meet the palliative needs of individuals with chronic heart failure. 9. Further research is needed on which palliative care model and method of delivery is best for individuals with chronic heart failure.

Date of Award	2019
Original language	English