End-of-life care conversations with heart failure patients: a systematic literature review and narrative synthesis
Stephen Barclay, Natalie Momen, Steve Case-Upton, Isla Kuhn, Elizabeth Smith, Stephen Barclay, Natalie Momen, Steve Case-Upton, Isla Kuhn, Elizabeth Smith
Abstract
Background: Current models of end-of-life care (EOLC) have been largely developed for cancer and may not meet the needs of heart failure patients.
Aim: To review the literature concerning conversations about EOLC between patients with heart failure and healthcare professionals, with respect to the prevalence of conversations; patients' and practitioners' preferences for their timing and content; and the facilitators and blockers to conversations.
Design of study: Systematic literature review and narrative synthesis.
Method: Searches of Medline, PsycINFO and CINAHL databases from January 1987 to April 2010 were conducted, with citation and journal hand searches. Studies of adult patients with heart failure and/or their health professionals concerning discussions of EOLC were included: discussion and opinion pieces were excluded. Extracted data were analysed using NVivo, with a narrative synthesis of emergent themes.
Results: Conversations focus largely on disease management; EOLC is rarely discussed. Some patients would welcome such conversations, but many do not realise the seriousness of their condition or do not wish to discuss end-of-life issues. Clinicians are unsure how to discuss the uncertain prognosis and risk of sudden death; fearing causing premature alarm and destroying hope, they wait for cues from patients before raising EOLC issues. Consequently, the conversations rarely take place.
Conclusion: Prognostic uncertainty and high risk of sudden death lead to EOLC conversations being commonly avoided. The implications for policy and practice are discussed: such conversations can be supportive if expressed as 'hoping for the best but preparing for the worst'.
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Source: PubMed