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Br J Gen Pract. 2011 Jan;61(582):e49-62. doi: 10.3399/bjgp11X549018.

End-of-life care conversations with heart failure patients: a systematic literature review and narrative synthesis.

Author information

  • 1General Practice and Primary Care Research Unit, Department of Public Health and Primary Care, Institute of Public Health, Cambridge. sigb2@medschl.cam.ac.uk

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'.

PMID:
21401993
[PubMed - indexed for MEDLINE]
PMCID:
PMC3020072
Free PMC Article

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