Feder Shelli, Iannone Lynne, Lendvai Dora, Zhan Yan, Akgün Kathleen, Ersek Mary, Luhrs Carol, Allen Larry A, Bekelman David B, Goldstein Nathan, Kavalieratos Dio
Yale School of Nursing, New Haven, CT; VA Connecticut Healthcare System, West Haven, CT.
VA Connecticut Healthcare System, West Haven, CT; Yale School of Medicine, New Haven, CT.
J Card Fail. 2025 Apr;31(4):611-620. doi: 10.1016/j.cardfail.2024.07.009. Epub 2024 Aug 2.
To elicit perspectives from specialist palliative care (SPC) and cardiology clinicians concerning the necessary components, delivery characteristics and implementation strategies of successful ambulatory SPC for people with heart failure (HF).
Palliative care is a recommended component of guideline-directed care for people with HF. However, optimal strategies to implement SPC within ambulatory settings are unknown.
We conducted a qualitative descriptive study composed of semistructured interviews with SPC and cardiology clinicians at Veterans Affairs Medical Centers (VAMCs) with the highest number of ambulatory SPC consultations within the VA system among people with HF between 2021 and 2022. Clinicians were asked how they provided ambulatory SPC and what they felt were the necessary components, delivery characteristics and implementation strategies of care delivery. Interviews were analyzed using directed content analysis.
We interviewed 14 SPC clinicians and 9 cardiology clinicians at 7 national VAMCs; 43% were physicians, and 48% were advanced-practice registered nurses/physician associates. Essential components of ambulatory SPC encompassed discussion of goals of care (eg, prognosis, advance directives) and connecting patients/caregivers to resources (eg, home care). Preferred delivery characteristics included integrated (ie, embedded) approaches to SPC delivery, standardized patient selection and referral procedures, and formalized procedures for handoffs to and from SPC. Strategies that addressed SPC implementation included deploying palliative champions, educating non-SPC clinicians on the value of ambulatory SPC for people with HF and developing ambulatory models through leadership support.
CONCLUSIONS/IMPLICATIONS: Facilitating the broader adoption of ambulatory SPC among people with HF may be achieved by prioritizing these mutually valued and necessary features of SPC delivery.
了解专科姑息治疗（SPC）和心脏病学临床医生对于成功开展心力衰竭（HF）患者门诊SPC的必要组成部分、服务特点和实施策略的看法。
姑息治疗是HF患者指南指导治疗的推荐组成部分。然而，在门诊环境中实施SPC的最佳策略尚不清楚。
我们进行了一项定性描述性研究，对2021年至2022年期间在退伍军人事务医疗中心（VAMC）中门诊SPC咨询量最高的HF患者进行了半结构化访谈，访谈对象为SPC和心脏病学临床医生。临床医生被问及他们如何提供门诊SPC，以及他们认为护理服务的必要组成部分、服务特点和实施策略是什么。采用定向内容分析法对访谈进行分析。
我们在7家全国性VAMC采访了14名SPC临床医生和9名心脏病学临床医生；43%为医生，48%为高级执业注册护士/医师助理。门诊SPC的基本组成部分包括护理目标的讨论（如预后、预立医嘱）以及将患者/护理人员与资源（如家庭护理）联系起来。首选的服务特点包括综合（即嵌入式）SPC服务方式、标准化的患者选择和转诊程序，以及SPC之间交接的正式程序。解决SPC实施问题的策略包括部署姑息治疗倡导者、对非SPC临床医生进行门诊SPC对HF患者价值的教育，以及通过领导支持开发门诊模式。
结论/启示：通过优先考虑SPC服务这些相互重视且必要的特征，可能会促进HF患者更广泛地采用门诊SPC。
