End-Of-Life Care: Doctors Reluctant To Discuss Issue With Chronic Heart Condition Patients

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Patients feel secure when given end-of-life care options, but only 12 percent of doctors admit to having the discussion. Photo courtesy of Shutterstock

With increased life expectancy and ever-increasing medical expenses, end-of-life care is becoming more of a necessity than a luxury. And for health care providers, unfortunately, end-of-life care discussions with their patients often do not occur. While patients may be appreciative of such discussions, according to a new study presented Wednesday at the Quality of Care and Outcomes Research 2014 Scientific Sessions, doctors may feel quite the opposite, especially when the discussions involve heart failure patients and their families.

The reasons for this reluctance could be a lack of time or that the doctors are uncomfortable broaching these topics with patients with chronic heart failure. Even though health care for heart diseases has improved considerably over the past decade, about 720,000 people have heart attacks in the United States every year and one in every four deaths is related to heart diseases, according to the Centers for Disease Control and Prevention.

Even though it is an acknowledged fact that heart failure cases will be better off with palliative care, it is not enforced in all cases, majorly due to a lack of communication, according to the press release.

Researchers surveyed 50 physicians and 45 nurse practitioners or physician assistants at three practices at the Mayo Clinic in Rochester, Minn., and the Mayo Clinic Health System. Ninety-five clinicians completed the survey.

The statistics showed that only 12 percent of clinicians admitted to having regular annual discussions about end-of-life care as advocated by the American Heart Association. Thirty percent reported being reluctant to discuss and even provide end-of-life care due to lack of confidence.

Among the 52 percent who said they felt hesitant mentioning end-of-life-care, 21 percent said it was the patients who weren’t ready to talk about issues, 11 percent said they were uncomfortable breaking the bad news, nine percent said they didn’t want to disappoint the family’s sense of hope, while eight percent said they lacked time.

There is also this confusion among providers about who should be discussing end-of-life care with patients. Sixty-three percent of heart failure specialists and 58 percent of community cardiology clinicians thought end-of-life care discussions were the responsibility of heart failure cardiologists, while 66 percent of primary care providers felt it was their responsibility.

But in spite of their reservations, 89 percent heart failure specialists and community cardiology clinicians reported to have referred heart failure patients to palliative care within the past year as compared to only 21 percent primary care physicians who have done the same.

"Providers did express an interest in receiving additional training to develop the skills and confidence to talk about end-of-life care with their patients with heart failure," said Dr. Shannon Dunlay, the study's lead researcher and a cardiologist at the Mayo Clinic in Rochester, Minn.

According to Dunlay, broaching discussions on end-of-life care may be difficult for doctors, but having an honest discussion about prognosis and treatment options gives patients a sense of hope.

"Communication is key but in many hospitals and health systems this can be difficult as patients often have multiple healthcare providers," Dunlay said. "Sometimes it's helpful to pick up the phone and have a provider-to-provider conversation so that everybody is on the same page. Incorporating end-of-life conversations into the ongoing, routine care of the patient is important as goals and preferences can change over time and patients and their families can feel more comfortable and confident in relaying their wishes to multiple providers."

 

Source: Dunlay S et al. American Heart Association's Quality of Care and Outcomes Research 2014 Scientific Sessions. 2014.

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