Study Of Palliative Care Practice Status In Patients With Heart Failure

Backgroud:Heart failure(HF)is now recognized as a major global public health concern,and its multiple symptoms affect patients’ quality of life and functional status.Palliative care focuses on improving the quality of life of patients and their families living with life-threatening illness at any stage of illness.Nowadays,western countries have achieved the integration of palliative care education,training and research.However,the cultural taboo of death and uncertainty in the prognosis make it reluctant for HF patients to access palliative care in China at this stage.Objetctives:To determine the Chinese culture oriented palliative care content for patients with HF,thus explore the current clinical practices.Methods:The palliative care concept in patients with HF was defined through Rodgers’ evolutionary concept analysis.Two-round Delphi consultations were conducted to confirm the Chinese culture oriented palliative care content for patients with HF.Explore the current clinical practices regarding palliative care in patients with HF by participatory observation and semi-structured interview.Results:1.The four attributes of palliative care in patients with HF include:symptom control aimed at improving life quality,holistic care focused on family,multi-disciplinary care,and personalized care emphasizing communication and consultation.2.The Chinese culture oriented palliative care content for patients with HF contained 4 primary indicators,including physical care,psychological support,spiritual support and family support,10 secondary indicators and 42 tertiary indicators.3.A total of 1130 observation fragments had been extracted of which,physical care,psychological support,spiritual support and family support incidence were 608,240,217,65 respectively.Comparing the observed content with the connotation of the service content,the degree of conformity is reported on a five-point Likert scale,from"totally inconsistent"(lowest score)to "very consistent"(highest score).The consistent degree of the two scores was 4.55 for physical care,3.98 for psychological support,3.84 for spiritual support,and 4.24 for family support.Totally 25 medical staff were interviewed.It was suggested that the cardiologist and cardiac nurses who had received palliative care training should be the main part of the palliative care team.Besides,it was pointed out that government support is an important prerequisite for developing palliative care in patients with HF in China.Conclusion:Currently,a lot of health care measures in the management of HF reflect the philosophy of palliative care,but not systematic and professional.The health care providers uphold the idea of shared medical decision-making,and highlight the patient-centered disease management.Control of physiological symptoms,comfort care and caregiver support have been underlined.Due to the limitations of the national conditions,family counseling,transitional care and measures involving death is not optimistic in China.