April 2018 post
4/5/2018 9:14:58 AM
What does the Advanced Heart Failure patient want?
In the preamble to their recent paper “Development and testing of a goals of care intervention in advanced heart failure” [Appl Nurs Res. 2017;38:99-106] Professor Cynthia M Dougherty and colleagues outline an array of options for the treatment of advanced heart failure (HF) that create – quite reasonably – the impression that we are in a golden age of therapeutic possibilities for this difficult condition: recurrent parenteral infusions, implanted ventricular assist devices and cardioverter defibrillators, cardiac transplantation, and the total artificial heart.
But is a life dominated by this panoply of interventions in every case what our patients want? Maybe; maybe not: and very likely not the same answer every time. We have a responsibility to identify their goals.
Dougherty and colleagues’ article is a contribution to the expanding science of “goals of care (GoC)”. I am not going to do them the discourtesy of trying to summarize a complex and supple piece of research in this short blog beyond revealing that giving patients’ the skills and confidence to initiate and maintain constructive conversations about what they want from their treatment emerges as a vital aspect of excellence in medical care for advanced heart failure.
In the authors’ own words “Holding a GoC conversation between patient and provider is expected to facilitate concordance between care received and the patient’s values and goals, assist in shared decision making about possible new HF therapies, improve patient-provider communication, and potentially improve quality of life.” We have to note that “is expected”: the outcome we aspire to may not be fully achieved in every case. But to aspire to those outcomes is from every point of view absolutely the right thing to do and I would urge all those involved in the care of patients with advanced heart failure to make a careful study of research on GoC (below are some other recent leads to get you started) and to bring well-founded understanding of patient goals and wishes into the heart of their practice.
• An Intervention to Enhance Goals-of-Care Communication Between Heart Failure Patients and Heart Failure Providers.[J Pain Symptom Manage. 2016]
• Does an intervention designed to improve self-management, social support and awareness of palliative-care address needs of persons with heart failure, family caregivers and clinicians?[J Clin Nurs. 2018]
• Feasibility and acceptability of a nursing intervention with family caregiver on self-care among heart failure patients: a randomized pilot trial.[Pilot Feasibility Stud. 2016]