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Systematic Methods to Assess End-of-Life and Palliative Care Needs for Heart Failure Home Care
Ubolrat Piamjariyakul1, Stephanie Young1, Angel Smothers1
1School of Nursing, West Virginia University, Morgantown, WV, USA.
The American Journal of Hospice & Palliative Care
|February 23, 2026
Summary
Home-based advanced heart failure management requires addressing palliative care needs. Integrating patient, caregiver, and nurse observations improves symptom control and safety for better quality of life.
Area of Science:
- Cardiology
- Palliative Care
- Nursing Research
Background:
- Advanced heart failure (HF) necessitates comprehensive home-based care, including palliative and end-of-life (EOL) support.
- Early identification of palliative care needs is crucial for enhancing patient and family quality of life and safety.
Purpose of the Study:
- To evaluate end-of-life (EOL) and palliative care needs in home-based advanced heart failure (HF) management.
- To utilize systematic nursing observations and validated assessment tools to identify these needs.
Main Methods:
- A descriptive, observational study involving 18 patients with HF and their caregivers in a rural Appalachian clinical trial.
- Data collection included the Integrated Palliative Care Outcome Scale (IPOS), EOL goals assessment, home safety checklist, and nurse observation notes.
Main Results:
- Patients with HF presented significant symptom burden and home safety issues.
- IPOS scores revealed persistent physical and psychosocial symptoms; advance care planning showed deficits.
- Nurse observations highlighted challenges in medication adherence and emotional distress, complementing questionnaire data.
Conclusions:
- Combining patient/caregiver perspectives with nurse assessments offers a holistic view of home palliative care needs.
- Proactive, home-based interventions informed by these integrated assessments enhance safety, symptom management, and shared decision-making.
- Patient-centered palliative care is essential for individuals with advanced HF, improving outcomes and quality of life.
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