Attitudes and practices towards palliative care in chronic heart failure: a survey of cardiovascular nurses and physicians

Abstract

Background

Heart failure is a chronic condition with various implications for individuals and families. Although the importance of implementing palliative care is recommended in best practice guidelines, implementation strategies are less clear.

Aims

This study sought to; (1) determine Australian and New Zealand cardiovascular nurses and physicians’ end of life care attitudes and specialist palliative care referral in heart failure and; (2) determine self-reported delivery of supportive care and attitudes towards service names.

Methods

An electronic survey was emailed to members of four peak bodies and professional networks. Participants were also recruited through social media. Paper-based versions of the survey were completed by attendees of the 66th Cardiac Society of Australia and New Zealand Annual Scientific Meeting, August 2018.

Findings

There were 113 completed responses included in the analyses. Participants were nurses (n = 75), physicians (n = 32) and allied health professionals (n = 4). Most (67%) reported they were comfortable with providing end of life care; however, fewer respondents agreed they received support for their dying patients and one-third experienced a sense of failure when heart failure progressed. Most (84–100%) participants agreed they would refer a heart failure patient later in the illness trajectory. There was a more favourable attitude towards the service name ‘supportive care’ than to ‘palliative care’.

Conclusion

Comfort with end of life discussions is encouraging as it may lead to a greater likelihood of planning future care and identifying palliative care needs. Peer support and supervision may be useful for addressing feelings of failure. The use of needs-based assessment tools, adopting the service name ‘supportive care’ and further research focusing on primary palliative team-based approach is required to improve palliative care access.

Impact statement

Cardiovascular nurses and physicians are comfortable providing end of life care, but referrals to palliative care in the later stages of heart failure persists.

Keywords:

• heart failure
• palliative care
• terminal care
• health personnel
• surveys and questionnaires

Acknowledgements

This work was supported by an Australian Government Research Training Program (RTP) Scholarship and by a PhD Scholarship from Western Sydney University.