When and how do we discuss prognosis and end-of-life with patients with heart failure?
A topic that is lately much discussed on cardiac congresses is the discussion of prognosis and end-of-life with patients with heart failure. Who is responsible to discuss these difficult topics? When should these topics be discussed and how do patients like to discuss this in their heart failure care?
In a recent doctoral thesis, Lisa Hjelmfors explored the prevalence and practice of nurses discussing prognosis and end-of-life care with patients with heart failure and the nurses’ perspectives regarding discussing prognosis and end-of-life care.
One of the articles presented in her thesis was accepted for a poster presentation at #AHA17 (see picture).
Prof. Lorraine Evangelista, Prof. Tiny Jaarsma, Prof. Anna Strömberg
Her research showed that most nurses discussed prognosis and end-of-life care with a patient with heart failure at some point in their clinical practice. Although they found that they have a role in these discussions, they found that the main responsibility for this discussion is with the physician. Together with sexuality, discussing prognosis and end-of-life are the least frequently discussed topics in heart failure clinics. I addressed in an earlier blog on sexual counselling in cardiac rehabilitation.
Lisa Hjelmfors points out that end-of life care should be included as a part of the daily routine at heart failure clinics and nurses should be encouraged to take more responsibility for discussing prognosis and end-of-life with patients and their care-givers.
Communication with patients with heart failure should always be tailored, this is strengthened by the findings in her research that patients have different preferences in discussing prognosis and end-of-life.
But a lot of research is yet to come. We have to find good ways to make it easier to discuss end-of-life and prognoses for both nurses and patients. End-of-life simulations could provide successful and appreciated learning situations for nursing students, teaching them communication skills in challenging situation. A prompt list could help patients to initiate discussion. Research is also needed on how to include care-givers in discussing end-of-life and prognosis and look at their perspectives on these discussions.
Click here to read Lisa her whole doctoral thesis.
Leonie Klompstra is a Nurse Scientist at the Linköping University in Sweden. Her primary focus is on heart failure and rehabilitations.