PCPs, Cardiologists Lack Confidence Needed for End-of-Life Discussions

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Karen Utterback By Karen Utterback 
Former Vice President, Product Marketing and Strategy, McKesson (Retired)
PCPs, Cardiologists Lack Confidence Needed for End-of-Life Discussions

In an American Heart Association study of 95 clinicians, researchers found 52% of providers are hesitant to mention end-of-life care with heart failure patients, 30% have little confidence in discussing or providing end-of-life care, and only 12% have routine yearly discussions about it.

Those numbers likely don’t surprise anyone in home health and hospice, but they’re nevertheless sobering. Clearly, more education and support are needed from those who understand palliative care and have strong end-of-life communication skills.

The study was presented at the Quality of Care and Outcomes Research 2014 Scientific Sessions in Baltimore in June. The survey was taken by 50 physicians and 45 physician assistants or nurse practitioners at the Mayo Clinic Health System and Mayo Clinic in Rochester, MN.

The main reasons cited for not discussing end-of-life care with heart failure patients was patient uneasiness (21%), their own discomfort with the subject (11%), a worry about destroying a sense of hope (9%) and a lack of time (8%).

Providers are also unsure about who should bring up end-of-life care — 63% of heart failure specialists and 58% of community cardiology clinicians believe the discussion should be conducted by heart failure cardiologists, but 66% of primary care providers feel it’s their responsibility.

Dr. Shannon Dunlay, a Mayo Clinic cardiologist and lead researcher on the study, said there’s no evidence that bringing up end-of-life care ruins hope, and it may ease anxiety for some patients.

Dunlay also noted that providers expressed 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. In addition to gaining these skills, providers would no doubt welcome the type of insights that home health and hospice organizations can offer into incorporating end-of-life discussions into patient care.

Learn more about the importance of physician-patient communication and end-of-life discussions.

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