Volume 29, Issue 9-10 pp. 1576-1589

ORIGINAL ARTICLE

Access and referral to palliative care for patients with chronic heart failure: A qualitative study of healthcare professionals

Gursharan K. Singh B Med Sci Hons,

Corresponding Author

Gursharan K. Singh B Med Sci Hons

PhD Candidate

[email protected]

orcid.org/0000-0003-1945-7556

School of Nursing & Midwifery, Western Sydney University, Sydney, NSW, Australia

Correspondence

Gursharan K. Singh, School of Nursing & Midwifery, Western Sydney University, Locked Bag 1797, Sydney, NSW 2751, Australia.

Email: [email protected]

Search for more papers by this author

Lucie Ramjan PhD, RN,

Lucie Ramjan PhD, RN

Associate Professor, Academic Course Advisor (International Programs)

orcid.org/0000-0001-7815-3005

School of Nursing & Midwifery, Western Sydney University, Sydney, NSW, Australia

Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia

Search for more papers by this author

Caleb Ferguson PhD, RN,

Caleb Ferguson PhD, RN

Senior Research Fellow

orcid.org/0000-0002-2417-2216

School of Nursing & Midwifery, Western Sydney University, Sydney, NSW, Australia

Western Sydney Local Health District, Blacktown Hospital, Blacktown, NSW, Australia

Search for more papers by this author

Patricia M. Davidson PhD, RN,

Patricia M. Davidson PhD, RN

Professor, Dean (School of Nursing)

orcid.org/0000-0003-0299-6289

School of Nursing, Johns Hopkins University, Baltimore, MD, USA

Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia

Search for more papers by this author

Phillip J. Newton PhD, RN,

Phillip J. Newton PhD, RN

Adjunct Professor

orcid.org/0000-0002-5006-2037

School of Nursing & Midwifery, Western Sydney University, Sydney, NSW, Australia

Search for more papers by this author

Gursharan K. Singh B Med Sci Hons,

Corresponding Author

Gursharan K. Singh B Med Sci Hons

PhD Candidate

[email protected]

orcid.org/0000-0003-1945-7556

School of Nursing & Midwifery, Western Sydney University, Sydney, NSW, Australia

Correspondence

Gursharan K. Singh, School of Nursing & Midwifery, Western Sydney University, Locked Bag 1797, Sydney, NSW 2751, Australia.

Email: [email protected]

Search for more papers by this author

Lucie Ramjan PhD, RN,

Lucie Ramjan PhD, RN

Associate Professor, Academic Course Advisor (International Programs)

orcid.org/0000-0001-7815-3005

School of Nursing & Midwifery, Western Sydney University, Sydney, NSW, Australia

Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia

Search for more papers by this author

Caleb Ferguson PhD, RN,

Caleb Ferguson PhD, RN

Senior Research Fellow

orcid.org/0000-0002-2417-2216

School of Nursing & Midwifery, Western Sydney University, Sydney, NSW, Australia

Western Sydney Local Health District, Blacktown Hospital, Blacktown, NSW, Australia

Search for more papers by this author

Patricia M. Davidson PhD, RN,

Patricia M. Davidson PhD, RN

Professor, Dean (School of Nursing)

orcid.org/0000-0003-0299-6289

School of Nursing, Johns Hopkins University, Baltimore, MD, USA

Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia

Search for more papers by this author

Phillip J. Newton PhD, RN,

Phillip J. Newton PhD, RN

Adjunct Professor

orcid.org/0000-0002-5006-2037

School of Nursing & Midwifery, Western Sydney University, Sydney, NSW, Australia

Search for more papers by this author

First published: 06 March 2020

https://doi.org/10.1111/jocn.15222

Citations: 12

Funding information

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors. Gursharan K. Singh is supported by an Australian Government Research Training Program (RTP) Scholarship and by a PhD Scholarship from Western Sydney University. Dr Caleb Ferguson is supported by a 2018 Postdoctoral Research Fellowship (Ref: 102168) from the National Heart Foundation of Australia.

Share a link

Email
Wechat
Bluesky

Abstract

Background

Palliative care for individuals with chronic heart failure is recommended for improving patients’ symptoms, function and overall quality of life. Despite this mandate, there is limited access and referral to specialist palliative care for individuals with chronic heart failure.

Objectives

To explore healthcare professionals’ perspectives on access to palliative care for patients with chronic heart failure, focussing on patient, provider and system factors.

Methods

Cardiologists, palliative care specialists, heart failure nurses and palliative care nurses in acute and community care settings were interviewed using semi-structured interviews. Purposive and snowball sampling methods were used for recruitment. Interview data were analysed using thematic analysis. The COREQ checklist guided data collection and reporting.

Results

There were 15 participants in the study, and the majority were female. Participants included palliative medicine physicians, a palliative care nurse consultant, cardiologists, a general practitioner and advanced heart failure nurses. The themes derived from the thematic analysis centred on patient, provider and system factors impacting access and referral to palliative care in the context of chronic heart failure. The patient themes were (a) patient and family preconception of palliative care and (b) patient's clinical profile influences referral. The provider themes were (a) conflict, (b) making decisions and (c) education needs, and the system themes were (a) accessing services and resources and (b) improving the model of care.

Conclusions

The patient's clinical profile, education needs of healthcare professionals and improving access to services and resources need to be considered to enhance palliative care access and referral as well as the interacting and influencing elements of the patient, provider and system.

CONFLICT OF INTEREST

None.

Supporting Information

REFERENCES

Assist, P. (2017). Introduction to Medicare Australia and the Medicare Benefits Schedule.
Google Scholar
Atherton, J. J., Sindone, A., De Pasquale, C. G., Driscoll, A., MacDonald, P. S., Hopper, I., … Connell, C. (2018). National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Guidelines for the Prevention, Detection, and Management of Heart Failure in Australia 2018. Heart Lung and Circulation, 27(10), 1123–1208. https://doi.org/10.1016/j.hlc.2018.06.1042
10.1016/j.hlc.2018.06.1042
PubMed Web of Science® Google Scholar
Beernaert, K., Deliens, L., De Vleminck, A., Devroey, D., Pardon, K., Van den Block, L., & Cohen, J. (2014). Early identification of palliative care needs by family physicians: A qualitative study of barriers and facilitators from the perspective of family physicians, community nurses, and patients. Palliative Medicine, 28(6), 480–490. https://doi.org/10.1177/0269216314522318
10.1177/0269216314522318
PubMed Web of Science® Google Scholar
Bekelman, D. B., Havranek, E. P., Becker, D. M., Kutner, J. S., Peterson, P. N., Wittstein, I. S., … Dy, S. M. (2007). Symptoms, depression, and quality of life in patients with heart failure. Journal of Cardiac Failure, 13(8), 643–648. https://doi.org/10.1016/j.cardfail.2007.05.005
10.1016/j.cardfail.2007.05.005
PubMed Web of Science® Google Scholar
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa
10.1191/1478088706qp063oa
Google Scholar
Currow, D. C., Smith, J., Davidson, P. M., Newton, P. J., Agar, M. R., & Abernethy, A. P. (2010). Do the trajectories of dyspnea differ in prevalence and intensity by diagnosis at the end of life? A consecutive cohort study. Journal of Pain and Symptom Management, 39(4), 680–690. https://doi.org/10.1016/j.jpainsymman.2009.09.017
10.1016/j.jpainsymman.2009.09.017
PubMed Web of Science® Google Scholar
Dai, Y. X., Chen, T. J., & Lin, M. H. (2017). Branding palliative care units by avoiding the terms “palliative” and “hospice”: A nationwide study in Taiwan. INQUIRY: the Journal of Health Care Organization, Provision, and Financing, 54, 004695801668644. https://doi.org/10.1177/0046958016686449
10.1177/0046958016686449
Web of Science® Google Scholar
Davidson, P. M., Cockburn, J., & Newton, P. J. (2008). Unmet needs following hospitalization with heart failure: Implications for clinical assessment and program planning. Journal of Cardiovascular Nursing, 23(6), 541–546. https://doi.org/10.1097/01.JCN.0000338927.43469.35
10.1097/01.JCN.0000338927.43469.35
PubMed Web of Science® Google Scholar
Davidson, P. M., Paull, G., Introna, K., Cockburn, J., Davis, J. M., Rees, D., … Dracup, K. (2004). Integrated, collaborative palliative care in heart failure: The St. George Heart Failure Service experience 1999–2002. Journal of Cardiovascular Nursing, 19(1), 68–75. https://doi.org/10.1097/00005082-200401000-00011
10.1097/00005082-200401000-00011
PubMed Google Scholar
Davidson, P. M., Paull, G., Rees, D., Daly, J., & Cockburn, J. (2005). Activities of home-based heart failure nurse specialists: A modified narrative analysis. American Journal of Critical Care, 14(5), 426–433.
10.4037/ajcc2005.14.5.426
PubMed Web of Science® Google Scholar
Department of Health, W. A (2008). Heart failure model of care. Perth, WA: Health Networks Branch, Department of Health.
Google Scholar
Evangelista, L. S., Liao, S., Motie, M., De Michelis, N., & Lombardo, D. (2014). On-going palliative care enhances perceived control and patient activation and reduces symptom distress in patients with symptomatic heart failure: A pilot study. European Journal of Cardiovascular Nursing, 13(2), 116–123. https://doi.org/10.1177/1474515114520766
10.1177/1474515114520766
PubMed Web of Science® Google Scholar
Evangelista, L. S., Lombardo, D., Malik, S., Ballard-Hernandez, J., Motie, M., & Liao, S. (2012). Examining the effects of an outpatient palliative care consultation on symptom burden, depression, and quality of life in patients with symptomatic heart failure. Journal of Cardiac Failure, 18(12), 894–899. https://doi.org/10.1016/j.cardfail.2012.10.019
10.1016/j.cardfail.2012.10.019
PubMed Web of Science® Google Scholar
Fadul, N., Elsayem, A., Palmer, J. L., Del Fabbro, E., Swint, K., Li, Z., … Bruera, E. (2009). Supportive versus palliative care: What's in a name? A survey of medical oncologists and midlevel providers at a comprehensive cancer center. Cancer, 115(9), 2013–2021. https://doi.org/10.1002/cncr.24206
10.1002/cncr.24206
CAS PubMed Web of Science® Google Scholar
Gadoud, A., & Johnson, M. (2010). Models of palliative care in advanced heart failure. MIMS Oncology & Palliative Care, 4, 30–32.
Google Scholar
Greener, D. T., Quill, T., Amir, O., Szydlowski, J., & Gramling, R. E. (2014). Palliative care referral among patients hospitalized with advanced heart failure. Journal of Palliative Medicine, 17(10), 1115–1120. https://doi.org/10.1089/jpm.2013.0658
10.1089/jpm.2013.0658
PubMed Web of Science® Google Scholar
Hanratty, B., Hibbert, D., Mair, F., May, C., Ward, C., Capewell, S., … Corcoran, G. (2002). Doctors' perceptions of palliative care for heart failure: Focus group study. British Medical Journal, 325(7364), 581–585. https://doi.org/10.1136/bmj.325.7364.581
10.1136/bmj.325.7364.581
PubMed Web of Science® Google Scholar
Hui, D., De La Cruz, M., Mori, M., Parsons, H. A., Kwon, J. H., Torres-Vigil, I., … Bruera, E. (2013). Concepts and definitions for "supportive care," "best supportive care," "palliative care," and "hospice care" in the published literature, dictionaries, and textbooks. Supportive Care in Cancer, 21(3), 659–685. https://doi.org/10.1007/s00520-012-1564-y
10.1007/s00520-012-1564-y
PubMed Web of Science® Google Scholar
Hui, D., Mori, M., Parsons, H. A., Kim, S. H., Li, Z., Damani, S., & Bruera, E. (2012). The lack of standard definitions in the supportive and palliative oncology literature. Journal of Pain and Symptom Management, 43(3), 582–592. https://doi.org/10.1016/j.jpainsymman.2011.04.016
10.1016/j.jpainsymman.2011.04.016
PubMed Web of Science® Google Scholar
Hupcey, J. E., Penrod, J., & Fenstermacher, K. (2009). A model of palliative care for heart failure. American Journal of Hospice & Palliative Medicine, 26(5), 399–404. https://doi.org/10.1177/1049909109333935
10.1177/1049909109333935
PubMed Web of Science® Google Scholar
Hupcey, J. E., Penrod, J., & Fogg, J. (2009). Heart failure and palliative care: Implications in practice. Journal of Palliative Medicine, 12(6), 531–536. https://doi.org/10.1089/jpm.2009.0010
10.1089/jpm.2009.0010
PubMed Web of Science® Google Scholar
Kavalieratos, D., Mitchell, E. M., Carey, T. S., Dev, S., Biddle, A. K., Reeve, B. B., … Weinberger, M. (2014). "Not the 'Grim Reaper service'": An assessment of provider knowledge, attitudes, and perceptions regarding palliative care referral barriers in heart failure. Journal of the American Heart Association, 3(1), 11. https://doi.org/10.1161/jaha.113.000544
10.1161/JAHA.113.000544
Web of Science® Google Scholar
Krum, H., Jelinek, M. V., Stewart, S., Sindone, A., Atherton, J. J., Hawkes, A. L., … Walsh, W. (2006). Guidelines for the prevention, detection and management of people with chronic heart failure in Australia 2006. Medical Journal of Australia, 185(10), 549–556. https://doi.org/10.5694/j.1326-5377.2006.tb00690.x
10.5694/j.1326-5377.2006.tb00690.x
PubMed Web of Science® Google Scholar
Lamont, E. B. (2005). A demographic and prognostic approach to defining the end of life. Journal of Palliative Medicine, 8(Suppl. 1), s-12–s-21. https://doi.org/10.1089/jpm.2005.8.s-12
Google Scholar
McEntee, M. L., Cuomo, L. R., & Dennison, C. R. (2009). Patient-, provider-, and system-level barriers to heart failure care. Journal of Cardiovascular Nursing, 24(4), 290–298. https://doi.org/10.1097/JCN.0b013e3181a660a0
10.1097/JCN.0b013e3181a660a0
PubMed Web of Science® Google Scholar
McMurray, J. J., & Stewart, S. (2000). Epidemiology, aetiology, and prognosis of heart failure. Heart, 83(5), 596–602.
10.1136/heart.83.5.596
CAS PubMed Web of Science® Google Scholar
Miller, N. H., Hill, M., Kottke, T., & Ockene, I. S. (1997). The multilevel compliance challenge: Recommendations for a call to action: A statement for healthcare professionals. Circulation, 95(4), 1085–1090. https://doi.org/10.1161/01.CIR.95.4.1085
10.1161/01.CIR.95.4.1085
CAS PubMed Web of Science® Google Scholar
Ponikowski, P., Voors, A. A., Anker, S. D., Bueno, H., Cleland, J. G. F., Coats, A. J. S., … van der Meer, P. (2016). 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European Heart Journal, 37(27), 2129–2200. https://doi.org/10.1093/eurheartj/ehw128
10.1093/eurheartj/ehw128
PubMed Web of Science® Google Scholar
Quill, T. E., & Abernethy, A. P. (2013). Generalist plus specialist palliative care – Creating a more sustainable model. New England Journal of Medicine, 368(13), 1173–1175. https://doi.org/10.1056/NEJMp1215620
10.1056/NEJMp1215620
CAS PubMed Web of Science® Google Scholar
Reid, P., Compton, W., Grossman, J., & Fanjiang, G. (2005). A framework for a systems approach to health care delivery Building a Better Delivery System: A New Engineering/Health Care Partnership (pp. 19–26).
Google Scholar
Singh, G. K., Davidson, P. M., Macdonald, P. S., & Newton, P. J. (2018). The perspectives of health care professionals on providing end of life care and palliative care for patients with chronic heart failure: An integrative review. Heart, Lung and Circulation, 28(4), 539–552. https://doi.org/10.1016/j.hlc.2018.10.009
10.1016/j.hlc.2018.10.009
PubMed Web of Science® Google Scholar
Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19(6), 349–357. https://doi.org/10.1093/intqhc/mzm042
10.1093/intqhc/mzm042
PubMed Web of Science® Google Scholar
Waller, A., Girgis, A., Davidson, P. M., Newton, P. J., Lecathelinais, C., Macdonald, P. S., … Currow, D. C. (2013). Facilitating needs-based support and palliative care for people with chronic heart failure: Preliminary evidence for the acceptability, inter-rater reliability, and validity of a needs assessment tool. Journal of Pain and Symptom Management, 45(5), 912–925. https://doi.org/10.1016/j.jpainsymman.2012.05.009
10.1016/j.jpainsymman.2012.05.009
PubMed Web of Science® Google Scholar
WHO. (2002). National cancer control programmes: Policies and managerial guidelines ( 2nd ed.). Geneva, Switzerland: WHO.
Google Scholar
Wong, R. C. C., Tan, P. T., Seow, Y. H., Aziz, S., Oo, N., Seow, S. C., … Chai, P. (2013). Home-based advance care programme is effective in reducing hospitalisations of advanced heart failure patients: A clinical and healthcare cost study. Annals Academy of Medicine Singapore, 42(9), 466–471.
PubMed Web of Science® Google Scholar
Wotton, K., Borbasi, S., & Redden, M. (2005). When all else has failed: Nurses’ perceptions of factors influencing palliative care for patients with end-stage heart failure. Journal of Cardiovascular Nursing, 20(1), 18–25. https://doi.org/10.1097/00005082-200501000-00006
10.1097/00005082-200501000-00006
PubMed Google Scholar
Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E., Drazner, M. H., … Wilkoff, B. L. (2013). 2013 ACCF/AHA Guideline for the management of heart failure a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation, 128(16), E240–E327. https://doi.org/10.1161/CIR.0b013e31829e8776
PubMed Web of Science® Google Scholar
Ziehm, J., Farin, E., Schafer, J., Woitha, K., Becker, G., & Koberich, S. (2016). Palliative care for patients with heart failure: Facilitators and barriers – A cross sectional survey of German healthcare professionals. BMC Health Services Research, 16, 10. https://doi.org/10.1186/s12913-016-1609-x
10.1186/s12913-016-1609-x
PubMed Web of Science® Google Scholar
Ziehm, J., Farin, E., Seibel, K., Becker, G., & Koberich, S. (2016). Health care professionals' attitudes regarding palliative care for patients with chronic heart failure: An interview study. BMC Palliative Care, 15, 8. https://doi.org/10.1186/s12904-016-0149-9
10.1186/s12904-016-0149-9
PubMed Web of Science® Google Scholar

Citing Literature

Volume29, Issue9-10

May 2020

Pages 1576-1589

Filename	Description
jocn15222-sup-0001-Supinfo.pdfPDF document, 481.7 KB	Supinfo
jocn15222-sup-0002-Supinfo.pdfPDF document, 271.1 KB	Supinfo

Access and referral to palliative care for patients with chronic heart failure: A qualitative study of healthcare professionals

Abstract

Background

Objectives

Methods

Results

Conclusions

CONFLICT OF INTEREST

Supporting Information

REFERENCES

Citing Literature

References

Information

About Wiley Online Library

Help & Support

Opportunities

Connect with Wiley

Access and referral to palliative care for patients with chronic heart failure: A qualitative study of healthcare professionals

Abstract

Background

Objectives

Methods

Results

Conclusions

CONFLICT OF INTEREST

Supporting Information

REFERENCES

Citing Literature

References

Related

Information