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Treatment
Table 32. Palliative and Supportive Care Domains to Improve
Processes of Care and Patient Outcomes
Palliative and
Supportive
Domains of Care What Palliative Care Adds to Overall HF Management
High-quality
communication
Central to palliative care approaches are communication and
patient-caregiver engagement techniques.
Conveyance of
prognosis
Palliative care specifically addresses patient and caregiver
understanding of disease, treatment, and prognosis. Research
suggests that patients tend to overestimate their survival and
overestimate the potential benefits of treatment. Objective risk
models can calibrate expectations, but discussion of uncertainty
should accompany prognostic conversations, oen summarized
as "hope for the best, plan for the worst."
Clarifying goals of
care
Management of patients with HF as their disease becomes
end-stage and death seems near includes decisions about when
to discontinue treatments designed primarily to prolong life
(e.g., ICD, hospitalization, tube feeding ), decisions on when
to initiate treatments to reduce pain and suffering that may
hasten death (e.g., narcotics), and decisions about the location
of death, home services, and hospice care. Exploring patients'
expressed preferences, values, needs, concerns, means and
desires through clinician-led discussion can clarify values-
treatment concordance and improve medical decision-making.
Shared decision-
making
Shared decision-making is a process by which patients and
clinicians work together to make optimal health care decisions
from medically reasonable options that align with what matters
most to patients. Shared decision-making requires: unbiased
medical evidence about the risks, benefits, and burdens of
each alternative, including no intervention; clinician expertise
in communication and tailoring that evidence for individual
patients; and patient goals and informed preferences.
Symptom
management
Dyspnea, fatigue, pain, nausea, depression, anxiety, and other
symptoms of HF refractory to cardiovascular therapies can
be partially remediated through palliative and supportive
approaches in addition to GDMT.
Caregiver support Care of the patient with heart failure should extend to their
loved ones, including beyond their death, to offer support to
families and help them cope with loss.
