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Published on: July 21, 2023
Promoting palliative care for people with heart failure: the P3HF study protocol
Yutong Men1, Nathan Wright2, Giselle O'Connor2
1Yale School of Public Health, 60 College St, New Haven, CT, 06510, USA. yutong.men@yale.edu.
BMC Palliative Care
|July 10, 2026
Summary
Palliative care improves quality of life for heart failure patients, but is underutilized. The Promoting Palliative Care for People with Heart Failure (P3HF) Clinical Decision Support (CDS) tool aims to increase palliative care consultations for hospitalized patients.
Area of Science:
- Cardiology
- Palliative Medicine
- Health Informatics
Background:
- Heart failure (HF) is a chronic, life-limiting illness with significant symptom burden and end-of-life suffering.
- Palliative care (PC) is recommended for HF patients but is received by fewer than 20%.
- The Promoting Palliative Care for People with Heart Failure (P3HF) Clinical Decision Support (CDS) tool was developed to address this gap.
Purpose of the Study:
- To describe the development of the P3HF CDS tool.
- To outline the protocol for a pragmatic randomized clinical trial evaluating the P3HF CDS tool's effectiveness.
- To assess the usability, acceptability, feasibility, and efficacy of the P3HF CDS tool in increasing inpatient palliative care consultations.
Main Methods:
- A pragmatic randomized clinical trial will be conducted at two urban hospitals within a single health system.
- Eligible patients include hospitalized adults (≥18 years) with heart failure, NT-proBNP ≥500 pg/mL, and recent IV diuretic use.
- A mixed-methods design will analyze EHR data, surveys, and interviews with clinicians to evaluate implementation outcomes and clinical efficacy.
Main Results:
- The P3HF CDS tool integrates a prognostic-risk model, tiered functionality, and behavioral nudges within the EHR.
- The primary clinical outcome is an increase in inpatient palliative care consultations.
- Secondary outcomes include increased outpatient PC referrals, improved advance care planning, higher hospice enrollment, and reduced hospital length of stay and readmissions.
Conclusions:
- The P3HF CDS tool is an evidence-based, user-informed intervention designed to facilitate timely palliative care for heart failure patients.
- The P3HF trial will provide crucial data on the acceptability and real-world effectiveness of this CDS tool in clinical settings.
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