What is Quality End-of-Life Care for Patients With Heart Failure? A Qualitative Study With Physicians
| Autor: | Caitlin Gutheil, Rebecca Hutchinson, Benjamin S. Wessler, Hayley Prevatt, Douglas B. Sawyer, Paul K. J. Han |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Aggressive care media_common.quotation_subject Psychological intervention Coding (therapy) 030204 cardiovascular system & hematology Physicians Primary Care Interviews as Topic 03 medical and health sciences 0302 clinical medicine Cardiologists Physicians Medicine Humans Quality (business) 030212 general & internal medicine Intensive care medicine Qualitative Research media_common Aged Quality of Health Care Original Research Receipt Heart Failure Terminal Care Quality and Outcomes business.industry Middle Aged medicine.disease humanities hospice Heart failure end‐of‐life care Female Cardiology and Cardiovascular Medicine business End-of-life care Qualitative research Health Services and Outcomes Research |
| Zdroj: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| ISSN: | 2047-9980 |
| Popis: | BackgroundAdvanced heart failure (AHF) carries a morbidity and mortality that are similar or worse than many advanced cancers. Despite this, there are no accepted quality metrics for end‐of‐life (EOL) care for patients with AHF.Methods and ResultsAs a first step toward identifying quality measures, we performed a qualitative study with 23 physicians who care for patients with AHF. Individual, in‐depth, semistructured interviews explored physicians' perceptions of characteristics of high‐quality EOL care and the barriers encountered. Interviews were analyzed using software‐assisted line‐by‐line coding in order to identify emergent themes. Although some elements and barriers of high‐quality EOL care for AHF were similar to those described for other diseases, we identified several unique features. We found a competing desire to avoid overly aggressive care at EOL alongside a need to ensure that life‐prolonging interventions were exhausted. We also identified several barriers related to identifying EOL including greater prognostic uncertainty, inadequate recognition of AHF as a terminal disease and dependence of symptom control on disease‐modifying therapies.ConclusionsOur findings support quality metrics that prioritize receipt of goal‐concordant care over utilization measures as well as a need for more inclusive payment models that appropriately reflect the dual nature of many AHF therapies. |
| Databáze: | OpenAIRE |
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