Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Division of Palliative Medicine, Brigham and Women's Hospital, Boston, MA, United States.
Heart Lung. 2025 Jan-Feb;69:1-10. doi: 10.1016/j.hrtlng.2024.09.004. Epub 2024 Sep 11.
Patients with advanced heart failure (AHF) desire communication around values and goals prior to treatment decisions.
To evaluate the timing and content of the first serious illness communication (SI conversation) for patients with AHF after referral to a specialist palliative care (PC) team (HeartPal).
In this retrospective cohort study, we used electronic health records to identify patients referred to HeartPal and their first SI conversations at a tertiary care hospital between October 2018 and September 2021. We used natural language processing and predetermined codes to quantify prevalence of prior goals of care conversations by the cardiology team within six months preceding the HeartPal consultation and the prevalence of hopes, fears, and seven conversation content codes. Consecutive SI conversations and patient outcomes were followed until March 2022.
Of 468 patients (mean age: 64 years, 72 % male, 66 % referred for goals of care conversation), 25.2 % had prior documented goals of care conversations preceding the HeartPal consultation. During the study period, 206 (44.0 %) patients died (median time from initial SI conversation to death: 65 days, IQR 206) and 43.2 % engaged in multiple SI conversations before death. SI conversation analysis (n = 324) revealed that patients hoped to "be at home" (74.1 %, n = 240), "be independent" (65.7 %, n = 213) and "live as long as possible" (53.4 %, n = 173). Conversation content included goals of care (83.0 %), strengths (83.0 %), decision-making (79.3 %), spirituality (71.0 %), coping (52.2 %), and prognostic communication (43.5 %).
Specialist PC service provides documentation of goals and values and offers longitudinal follow-up for patients with AHF.
患有晚期心力衰竭（AHF）的患者在治疗决策前希望就价值观和目标进行沟通。
评估患者在转诊至专科姑息治疗（PC）团队（HeartPal）后首次与 AHF 相关的严重疾病沟通（SI 对话）的时机和内容。
在这项回顾性队列研究中，我们使用电子健康记录来识别 2018 年 10 月至 2021 年 9 月期间在一家三级保健医院转诊至 HeartPal 的患者及其首次 SI 对话。我们使用自然语言处理和预定的代码来量化在 HeartPal 咨询前六个月心内科团队进行的先前治疗目标对话的发生率，以及希望、恐惧和七个对话内容代码的发生率。连续的 SI 对话和患者结局一直随访到 2022 年 3 月。
在 468 名患者（平均年龄：64 岁，72%为男性，66%因治疗目标而转诊）中，25.2%的患者在 HeartPal 咨询前有记录的先前治疗目标对话。在研究期间，206 名（44.0%）患者死亡（从初次 SI 对话到死亡的中位时间：65 天，IQR 206），43.2%的患者在死亡前进行了多次 SI 对话。SI 对话分析（n=324）显示，患者希望“居家”（74.1%，n=240）、“独立”（65.7%，n=213）和“尽可能长寿”（53.4%，n=173）。对话内容包括治疗目标（83.0%）、优势（83.0%）、决策（79.3%）、精神性（71.0%）、应对（52.2%）和预后沟通（43.5%）。
专科 PC 服务提供了关于 AHF 患者的目标和价值观的记录，并为其提供了纵向随访。
