Protocol driven palliative care consultation: Outcomes of the ENABLE CHF-PC pilot study
Rachel Wells1, Deborah Ejem1, J Nicholas Dionne-Odom1
1School of Nursing, University of Alabama at Birmingham, MT412B, 1720 2nd Avenue South, Birmingham, AL 35294-1210, USA.
Heart & Lung : the Journal of Critical Care
|August 26, 2018
Summary
Protocol-driven outpatient palliative care consultations (OPCC) for advanced heart failure (HF) assess medical and social history, focusing on goals of care. Regional differences impact OPCC completion and evaluated topics.
Area of Science:
- Palliative Care
- Cardiology
- Health Services Research
Background:
- Limited data exists on protocol-driven outpatient palliative care consultation (OPCC) for advanced heart failure (HF).
- Early palliative care interventions aim to improve outcomes for HF patients.
Purpose of the Study:
- To describe evaluation practices and treatment recommendations during protocol-driven OPCCs for advanced HF.
- To identify differences in OPCC content and completion rates based on region.
Main Methods:
- Content analysis of OPCCs from the ENABLE CHF-PC study (Northeast and Southeast sites).
- Statistical tests (t-tests, Fisher's exact, Chi-square) used to compare sociodemographic, outcome, and site-specific content differences.
Main Results:
- 39 out of 61 (64%) advanced HF participants received an OPCC.
- Key assessments included social/medical history, close relationships, family support, advance directive status, functional status, mood, breathlessness, and chest pain.
- Treatment recommendations focused on care coordination and specialty referrals, with significant regional variations in family support, code status, goals of care, and prognosis discussions.
Conclusions:
- Outpatient palliative care consultations for advanced HF effectively evaluate medical/social history, symptoms, and goals of care.
- Significant regional disparities exist in OPCC completion rates and the depth of discussions regarding care preferences and prognosis.
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