Key result
Physicians and nurses in a cardiology department hold heterogeneous, individual perceptions of end-of-life situations that are not yet aligned with professional society recommendations.
This qualitative study highlights that current end-of-life practices in cardiology are heterogeneous and heavily focused on curative measures, indicating a need for better alignment with palliative care guidelines.
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Cardiology departments may require targeted interventions to align end-of-life perceptions with recommendations; leaves open the efficacy of such approaches in practice.
BACKGROUND: Professional societies call for integration of end-of-life discussions early in the trajectory of heart failure, yet it remains unclear where current practices stand in relation to these recommendations. We sought to describe the perceptions and attitudes of caregivers in cardiology regarding end-of-life situations. METHODS: We performed a qualitative study using semi-directive interviews in the cardiology department of a university teaching hospital in France. Physicians, nurses and nurses' aides working full-time in the department at the time of the study were eligible. Participants were asked to describe how they experienced end-of-life situations. Interviews were recorded, transcribed and coded using thematic analysis to identify major and secondary themes. RESULTS: All physicians (N = 16)(average age 43.5 ± 13 years), 16 nurses (average age 38.5 ± 7.6 years) and 5 nurses' aides (average age 49 ± 7.8 years) participated. Interviews were held between 30 March and 17 July 2017. The main themes to emerge from the physicians' discourse were the concept of cardiology being a very active discipline, and a very curative frame of mind was prevalent. Communication (with paramedical staff, patients and families) was deemed to be important. Advance directives were thought to be rare, and not especially useful. Nurses also reported communication as a major issue, but their form of communication is bounded by several factors (physicians' prior discourse, legislation). They commonly engage in reconciling: between the approach (curative or palliative) and the reality of the treatment prescribed; performing curative interventions in patients they deem to be dying cases causes them distress. The emergency context prevents nurses from taking the time necessary to engage in end-of-life discussions. They engage in comfort-giving behaviors to maximize patient comfort. CONCLUSION: Current perceptions and practices vis-à-vis end-of-life situations in our department are individual, heterogeneous and not yet aligned with recommendations of professional societies.
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Ecarnot et al. (2018) studied End-of-life situations in cardiology (n=37). End-of-life care perceptions and practices was evaluated on Perceptions and attitudes regarding end-of-life situations. Physicians and nurses in a cardiology department hold heterogeneous, individual perceptions of end-of-life situations that are not yet aligned with professional society recommendations.
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