Exploring Health Care Providers' Experiences of Providing Collaborative Palliative Care for Patients With Advanced Heart Failure At Home: A Qualitative Study. Journal of the American Heart Association Background The HeartFull Collaborative is a regionally organized model of care which involves specialist palliative care and cardiology health care providers (HCPs) in a collaborative, home-based palliative care approach for patients with advanced heart failure (AHF). We evaluated HCP perspectives of barriers and facilitators to providing coordinated palliative care for patients with AHF at home. Methods and Results We conducted a qualitative study with 17 HCPs (11 palliative care and 6 cardiology) who were involved in the HeartFull Collaborative from April 2013 to March 2020. Individual, semi-structured interviews were held with each practitioner from November 2019 to March 2020. We used an interpretivist and inductive thematic analysis approach. We identified facilitators at 2 levels: (1) individual HCP level (on-going professional education to expand competency) and (2) interpersonal level (shared care between specialties, effective communication within the care team). Ongoing barriers were identified at 2 levels: (1) individual HCP level (e.g. apprehension of cardiology practitioners to introduce palliative care) and (2) system level (e.g. lack of availability of personal support worker hours). Conclusions Our results suggest that a collaborative shared model of care delivery between palliative care and cardiology improves knowledge exchange, collaboration and communication between specialties, and leads to more comprehensive patient care. Addressing ongoing barriers will help improve care delivery. Findings emphasize the acceptability of the program from a provider perspective, which is encouraging for future implementation. Further research is needed to improve prognostication, assess patient and caregiver perspectives regarding this model of care, and assess the economic feasibility and impact of this model of care. 10.1161/JAHA.121.024628

Carers' needs in advanced heart failure: A systematic narrative review. European journal of cardiovascular nursing BACKGROUND:Informal caregivers play a pivotal role in the care of people living with advanced heart failure, however, carers' needs have not been clearly identified. AIM:The aim of this study is to explore the evidence on palliative care needs expressed by carers of people with heart failure. METHODS:Five electronic databases (CINAHL PLUS, EMBASE, Medline, PsychInfo and SCOPUS) were systematically searched and articles published January 2003-June 2014 with a qualitative methodology focusing on the palliative care needs of carers of people living with heart failure were included. RESULTS:Data was systematically extracted from 15 articles using an inductive methodology for the thematic analysis. Ten broad categories emerged from which three key areas of support needs were identified; psychosocial support to maintain a sense of normalcy; support with daily living; support navigating the healthcare system. The articles were predominantly published in the UK and USA with a total sample size across all articles of 270, the majority of which were older female spouses. Results included a combination of carers, patients and professionals thoughts, however data was extracted for carers only. CONCLUSIONS:Carer's needs initiate when the patient is diagnosed and continue throughout the disease into bereavement. These needs are continuously prioritised and reprioritised depending on the patients' medical stability. A holistic approach is needed to support these carers, incorporating heart failure and palliative care specialties. Further research is warranted to explore different methods of delivering support and information and to evaluate whether these reduce carer burden. 10.1177/1474515115585237

Are family carers part of the care team providing end-of-life care? A qualitative interview study on the collaboration between family and professional carers. Vermorgen Maarten,Vandenbogaerde Isabel,Van Audenhove Chantal,Hudson Peter,Deliens Luc,Cohen Joachim,De Vleminck Aline Palliative medicine BACKGROUND:The attention of healthcare professionals is directed mainly towards the recipients of care and often insufficiently towards family carers. However, an effective collaboration between professionals and family carers is vital to provide quality palliative and end-of-life care. Such collaboration is under-studied in a palliative care context. AIM:This study aimed to investigate how family carers of people who live at home with a life-limiting chronic illness experience and perceive collaboration with different healthcare professionals in the last phase of life. DESIGN:Face-to-face semi-structured interviews were conducted with the primary family carers of people with a life-limiting chronic illness. Interpretative phenomenological analysis was used to analyse the data. SETTING/PARTICIPANTS:A heterogeneous sample of 30 family carers of people with cancer, heart failure or dementia was recruited through a variety of care providers and services, in order to reflect the heterogeneity of caregiving in serious illness. RESULTS:Five main themes emerged from interpretative phenomenological analysis that describe the quality of the collaboration between family carers and professionals: respecting family carers both as someone with care needs and as a member of the care team; the continuous availability and accessibility of healthcare professionals; the provision of information and communication including family carer issues; the coordination of care between all parties and contextual factors. The dominant experience by family carers was one of missed opportunities across these themes. CONCLUSIONS:This qualitative study about the experiences and perceptions of family carers of people with a chronic life-limiting illness living at home regarding the collaboration with different healthcare providers in the last phase life, showed that family carers experience a lot of possibilities, but perceive missed opportunities as well, for healthcare professionals to effectively collaborate with them for palliative care. 10.1177/0269216320954342