Affiliation: | 1. School of Nursing, University of Alabama at Birmingham, MT412B, 1720 2nd Avenue South, Birmingham, AL 35294-1210, USA;2. Cardiology, Dartmouth-Hitchcock Medical Center/Geisel School of Medicine at Dartmouth, Heart and Vascular Center DHMC, 1 Medical Center Drive, Lebanon, NH 03756, USA;3. 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;4. Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA |
Abstract: | BackgroundLittle has been reported about protocol-driven outpatient palliative care consultation (OPCC) for advanced heart failure (HF).ObjectivesTo describe evaluation practices and treatment recommendations made during protocol-driven OPCCs for advanced HF.MethodsWe 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.ResultsOf 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%).ConclusionOPCCs 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. |