Palliative Care Eases Burden on Heart Patients and Families
Dr Alina Ng | Research Assistant Professor
Heart failure is a serious condition affecting at least 26 million people worldwide and it is increasing in prevalence.1 Heart failure means that the heart is not pumping as well as it should be. There is usually no cure and when a patient reaches end-stage heart failure, their condition has progressed to the point where conventional therapies are no longer working or are not suitable for use. Palliative care is being increasingly integrated in heart failure disease management, and, a study that I led has demonstrated that palliative care can bring benefits both to these patients and their caregivers.
Most other research in palliative care has focused on the terminally ill or patients with cancer, but our research provides evidence that it has benefits beyond those areas, where the impact of such care approach is being recognized recently.2
A key aspect of our study was that we focused on homebased transitional care, which uses relatively fewer resources to support post-discharge ESHF patients. We studied 84 patients who were recently discharged from hospital. They were divided into two groups, one that received a 12-week structured programme of regular visits and phone calls with a nursing care manager who are specialist in palliative care and volunteers, and the other that received two social calls.
The outcomes were encouraging. Participants in the intervention group reported an enhanced quality of life across physical, psychosocial and existential aspects; good control of symptoms; more satisfaction with their care; and for caregivers, a reduced sense of burden in the hospital-to-home transition.3
We also found that the palliative care model had the potential to reduce distress for some symptoms. We produced new information showing that fatigue was improved for the intervention group in the longer-term follow-up observations, which may have been due to energy conservation techniques that the palliative care nurse care manager had taught the patients for managing their daily symptoms.
Symptom improvements may also have been helped by mutual goal setting between the patient and nurse care manager, better education about salt and fluid intake, and medication reconciliation. Regular scheduled contacts with patients also ensured that there was ongoing clinical surveillance and the possibility of detecting instability that might require referral to health services.
Overall, the results underline the importance of nursing specialisation. Nurses who specialise in palliative care have the advanced skills necessary to manage clients with complex palliative care needs. This kind of specialisation is important for both nurses and patients. On the one hand, nurses acquire a depth of knowledge that contributes to personal and professional growth, and on the other hand they can help patients to achieve better outcomes through earlier identification of problematic events or symptoms and knowledge of effective treatments.
Being able to provide competent intervention to patients can come easier once nurses have advanced training.
References
- Savarese, G., & Lund, L. H. (2017). Global public health burden of heart failure. Cardiac Failure Review, 3(1), 7.
- Sahlollbey, N., Lee, C. K. S., Shirin, A., & Joseph, P. (2020). The impact of palliative care on clinical and patient‐centred outcomes in patients with advanced heart failure: a systematic review of randomized controlled trials. European Journal of Heart Failure, (22), 2340-2346.
- Ng, A. Y. M., & Wong, F. K. Y. (2018). Effects of a home-based palliative heart failure program on quality of life, symptom burden, satisfaction and caregiver burden: A randomized controlled trial. Journal of Pain and Symptom Management, 55(1), 1-11.