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Author Spotlight: Workflow for Integrating POCUS Data into EHR for Managing Heart Failure Patients
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A study to improve communication between clinicians and patients with advanced heart failure: methods and challenges

Nathan E Goldstein1, Jill Kalman2, Jean S Kutner3

  • 1Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA.

Journal of Pain and Symptom Management
|April 29, 2014
PubMed

Insights

This study faced challenges in implementing a trial to improve discussions about implantable cardioverter defibrillators (ICDs) for advanced heart failure patients. Solutions were developed to overcome barriers related to palliative care, patient identification, and evolving treatment options.

Area of Science:

  • Cardiology
  • Palliative Care
  • Clinical Trials

Background:

  • Advanced heart failure (HF) patients with implantable cardioverter defibrillators (ICDs) require sensitive communication regarding deactivation.
  • Improving patient-provider communication is crucial for end-of-life care in advanced HF.

Purpose of the Study:

  • To describe the implementation challenges and solutions for a multicenter trial (Working to Improve Discussions About Defibrillator Management) focused on ICD deactivation conversations.
  • To assess the impact of an intervention on increasing ICD deactivation discussions, actual deactivations, and caregiver psychological outcomes.
  • To identify and address barriers in conducting research with advanced HF patients and their caregivers.

Main Methods:

  • A multicenter, randomized trial comparing usual care to an intervention for HF clinicians.
  • The intervention included educational sessions, clinician reminders, and individualized feedback.
  • Patients with advanced HF and their caregivers were enrolled and surveyed to evaluate communication improvements.

Main Results:

  • Implementation barriers included institutional review board concerns regarding palliative care, difficulties defining high-risk patient criteria, and adapting to changing ventricular assist device and transplant eligibility.
  • Novel solutions were developed to overcome these identified barriers.
  • The study provides insights into enhancing the conduct of future research in advanced illness care.

Conclusions:

  • Conducting trials on ICD deactivation in advanced HF presents unique challenges.
  • Adaptability and innovative problem-solving are essential for successful implementation of such studies.
  • This research offers valuable lessons for future trials aimed at improving end-of-life care for patients with advanced cardiovascular conditions.

Keywords:
Heart failureIRBcommunicationinterventionmethodspalliative carerandomized controlled trial

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