Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai (M.B., N.E.G., L.P.G.), New York, New York, USA.
School of Nursing and Department of Medicine, Division of Geriatrics, Gerontology, and Palliative Care (A.B., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama, USA.
J Pain Symptom Manage. 2023 Jul;66(1):62-69.e5. doi: 10.1016/j.jpainsymman.2023.03.009. Epub 2023 Mar 25.
Palliative care is guideline-recommended for patients with advanced heart failure (HF). However, studies on how cardiac palliative care is provided in the United States are lacking.
To study how cardiac palliative care programs provide services, and to identify challenges and facilitators they encountered in program development.
In this qualitative descriptive study, we used purposive and snowball sampling approaches to identify cardiac palliative care program leaders across the United States, administered a survey and conducted semi-structured interviews. Interview transcripts were coded and evaluated using thematic analysis.
While cardiac palliative care programs vary in their organizational setup, they all provide comprehensive interdisciplinary palliative care services, ideally across the care continuum. They predominantly serve HF patients who are evaluated for advanced therapies or have complex needs. The challenges which cardiac palliative care programs face include reaching those cardiac patients who need palliative care the most and collaborating with cardiologists who do not see value added from palliative care for their patients. Facilitators of cardiac palliative care program development include building personal relationships with cardiology providers, proactively assessing local institution needs, and tailoring palliative care services to meet patient and provider needs.
Cardiac palliative care programs vary in their organizational setup but provide similar services and face similar challenges. The challenges and facilitators we identified can inform the development of future cardiac palliative care programs.
姑息治疗是指南推荐给晚期心力衰竭（HF）患者的治疗方法。然而，美国在心脏姑息治疗方面的研究却很少。
研究心脏姑息治疗项目如何提供服务，并确定在项目开发过程中遇到的挑战和促进因素。
在这项定性描述性研究中，我们使用了目的性和滚雪球抽样方法，在美国各地确定了心脏姑息治疗项目的领导者，对他们进行了调查和半结构化访谈。对访谈记录进行了编码，并使用主题分析进行了评估。
虽然心脏姑息治疗项目在组织设置上有所不同，但它们都提供了全面的跨学科姑息治疗服务，理想情况下是在整个护理连续体中提供服务。它们主要服务于接受高级治疗评估或有复杂需求的 HF 患者。心脏姑息治疗项目面临的挑战包括接触最需要姑息治疗的心脏患者，以及与不认为姑息治疗对其患者有附加值的心脏病专家合作。心脏姑息治疗项目发展的促进因素包括与心脏病学提供者建立个人关系，主动评估当地机构的需求，以及定制姑息治疗服务以满足患者和提供者的需求。
心脏姑息治疗项目在组织设置上有所不同，但提供类似的服务，并面临类似的挑战。我们确定的挑战和促进因素可以为未来的心脏姑息治疗项目的发展提供信息。
