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Heart Lung. 2018 Nov;47(6):533-538. doi: 10.1016/j.hrtlng.2018.06.012. Epub 2018 Aug 22.

Protocol driven palliative care consultation: Outcomes of the ENABLE CHF-PC pilot study.

Author information

1
School of Nursing, University of Alabama at Birmingham, MT412B, 1720 2nd Avenue South, Birmingham, AL 35294-1210, USA. Electronic address: raduncan@uab.edu.
2
School of Nursing, University of Alabama at Birmingham, MT412B, 1720 2nd Avenue South, Birmingham, AL 35294-1210, USA.
3
Cardiology, Dartmouth-Hitchcock Medical Center/Geisel School of Medicine at Dartmouth, Heart and Vascular Center DHMC, 1 Medical Center Drive, Lebanon, NH 03756, USA.
4
Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, UAB Center for Palliative & Supportive Care, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-0012, USA; Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA.
5
School of Nursing, University of Alabama at Birmingham, MT412B, 1720 2nd Avenue South, Birmingham, AL 35294-1210, USA; Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, UAB Center for Palliative & Supportive Care, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-0012, USA.

Abstract

BACKGROUND:

Little has been reported about protocol-driven outpatient palliative care consultation (OPCC) for advanced heart failure (HF).

OBJECTIVES:

To describe evaluation practices and treatment recommendations made during protocol-driven OPCCs for advanced HF.

METHODS:

We performed content analysis of OPCCs completed as part of ENABLE CHF-PC, an early palliative care HF intervention, conducted at sites in the Northeast and Southeast. T-tests, Fisher's exact, and Chi-square tests were used to evaluate sociodemographic, outcome measures, and site content differences.

RESULTS:

Of 61 ENABLE CHF-PC participants, 39 (64%) had an OPCC (Northeast, n=27; Southeast, n=12). Social and medical history assessed most were close relationships (n=35, 90%), family support (n=33, 85%), advance directive status (n=33, 85%), functional status (n=30, 77%); and symptoms were mood (n= 35, 90%), breathlessness (n=28, 72%), and chest pain (n=24, 62%). Treatment recommendations focused on care coordination (n=13, 33%) and specialty referrals (n=12, 31%). Between-site OPCC differences included assessment of family support (Northeast vs. Southeast: 100% vs. 50%), code status (96% vs. 58%), goals of care discussions (89% vs. 41.7%), and prognosis understanding (85% vs. 33%).

CONCLUSION:

OPCCs for HF focused on evaluating medical and social history, along with goals of care and code status discussions. Symptom evaluation commonly included mood disorders, pain, dyspnea, and fatigue. Notable regional differences were found in topics evaluated and OPCC completion rates.

KEYWORDS:

Content analysis; Heart failure; Outpatient supportive care

PMID:
30143363
DOI:
10.1016/j.hrtlng.2018.06.012
[Indexed for MEDLINE]

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