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Prognosis Communication in Heart Failure: Experiences and Preferences of End-Stage Heart Failure Patients and Care Partners.
Shore, Supriya; Harrod, Molly; Vitous, Ann; Silveira, Maria J; McIlvennan, Colleen K; Cascino, Thomas M; Langa, Kenneth M; Ho, P Michael; Nallamothu, Brahmajee K.
Afiliación
  • Shore S; Division of Cardiovascular Disease, Department of Internal Medicine (S.S., T.C., B.K.N.), University of Michigan, Ann Arbor.
  • Harrod M; Center for Clinical Management Research (M.H.), VA Ann Arbor Health Care System, MI.
  • Vitous A; Geriatric Research and Clinical Center (A.V.), VA Ann Arbor Health Care System, MI.
  • Silveira MJ; Division of Geriatric and Palliative Medicine, Department of Internal Medicine (M.J.S.), University of Michigan, Ann Arbor.
  • McIlvennan CK; Division of Cardiology, Department of Medicine, University of Colorado, Aurora (C.K.M.I., P.M.H.).
  • Cascino TM; Division of Cardiovascular Disease, Department of Internal Medicine (S.S., T.C., B.K.N.), University of Michigan, Ann Arbor.
  • Langa KM; Department of Internal Medicine, Institute for Social Research (K.M.L.), University of Michigan, Ann Arbor.
  • Ho PM; Division of Cardiology, Department of Medicine, University of Colorado, Aurora (C.K.M.I., P.M.H.).
  • Nallamothu BK; Division of Cardiovascular Disease, Department of Internal Medicine (S.S., T.C., B.K.N.), University of Michigan, Ann Arbor.
Circ Cardiovasc Qual Outcomes ; 17(6): e010662, 2024 Jun.
Article en En | MEDLINE | ID: mdl-38775053
ABSTRACT

BACKGROUND:

Patients with heart failure (HF) overestimate survival compared with model-predicted estimates, but the reasons for this discrepancy are poorly understood. We characterized how patients with end-stage HF and their care partners understand prognosis and elicited their preferences around prognosis communication.

METHODS:

We conducted in-depth, semistructured interviews with patients with end-stage HF and their care partners between 2021 and 2022 at a tertiary care center in Michigan. Participants were asked to describe barriers they faced to understanding prognosis. All interviews were coded and analyzed using an iterative content analysis approach.

RESULTS:

Fifteen patients with end-stage HF and 15 care partners participated, including 7 dyads. The median patient age was 66.5 years (range, 31-80) and included 9 of 15 (60%) White participants and 9 of 15 (60%) were males. Care partners included 10 of 15 (67%) White participants and 6 of 15 (40%) were males. Care partners were partners (n=7, 47%), siblings (n=4, 27%), parents (n=2, 13%), and children (n=2, 13%). Most patients demonstrated a poor understanding of their prognosis. In contrast, care partners commonly identified the patient's rapidly declining trajectory. Patients and care partners described ineffective prognosis communication with clinicians, common barriers to understanding prognosis, and similar suggestions on improving prognosis communication. Barriers to understanding prognosis included (1) conversation avoidance by physicians, (2) information inconsistency across different physicians, (3) distractions during prognosis communication due to emphasis on other conditions, and (4) confusion related to the use of medical jargon. Most patients and care partners wanted discussions around prognosis to begin early in the course of the disease, repeated routinely using layperson's terms, incorporating both quality of life and survival assessments, and involving care partners. Both patients and care partners did not expect precise survival estimates.

CONCLUSIONS:

Patients with end-stage HF demonstrate a poor understanding of their prognosis compared with their care partners. Patients and care partners are open to discussing prognosis early, using direct and patient-centered language.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Conocimientos, Actitudes y Práctica en Salud / Entrevistas como Asunto / Cuidadores / Prioridad del Paciente / Insuficiencia Cardíaca Límite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: Circ Cardiovasc Qual Outcomes Asunto de la revista: ANGIOLOGIA / CARDIOLOGIA Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Conocimientos, Actitudes y Práctica en Salud / Entrevistas como Asunto / Cuidadores / Prioridad del Paciente / Insuficiencia Cardíaca Límite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: Circ Cardiovasc Qual Outcomes Asunto de la revista: ANGIOLOGIA / CARDIOLOGIA Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos