Why the study?
The Needs Assessment Tool: Progressive Disease - Heart Failure (NAT:PD-HF) identifies and triages palliative care needs, but a Dutch version was lacking.
Does the Dutch NAT:PD-HF identify palliative care needs and trigger appropriate actions in outpatients with advanced chronic heart failure?
Does the Dutch NAT:PD-HF identify palliative care needs and trigger appropriate actions in outpatients with advanced chronic heart failure?
The Dutch NAT:PD-HF is an acceptable tool that successfully identifies palliative care needs in advanced heart failure patients, though its implementation should be paired with communication skills training.
NAT:PD-HF shows moderate acceptability and identifies needs in advanced HF outpatients; hypothesis-generating for action uptake and training needs.
BACKGROUND: The Needs Assessment Tool: Progressive Disease - Heart Failure (NAT:PD-HF) was developed to identify and triage palliative care needs in patients with chronic heart failure. A Dutch version is currently lacking. AIMS: The aim of this study was to investigate the feasibility and acceptability of a Dutch NAT:PD-HF in chronic heart failure outpatients; and to gain preliminary data regarding the effect of the NAT:PD-HF on palliative care referral, symptoms, health status, care dependency, caregiver burden and advance directives. METHODS: A mixed methods study including 23 outpatients with advanced chronic heart failure and 20 family caregivers was performed. Nurses conducted patient consultations using a Dutch translation of the NAT:PD-HF and rated acceptability. Before this visit and 4 months later, symptoms, health status, performance status, care dependency, caregiver burden and recorded advance directives were assessed. A focus group with participating nurses discussed barriers and facilitators towards palliative care needs assessment. RESULTS: Acceptability was rated as 7 (interquartile range 6-7 points) on a 10-point scale. All patients had palliative care needs. In 48% actions were taken, including two patients referred to palliative care. Symptoms, performance status, care dependency, caregiver burden and advance directives were unchanged at 4 months, while health status deteriorated in patients completing follow-up ( n=17). Barriers towards palliative care needs assessment included feeling uncomfortable to initiate discussions and concerns about the ability to address palliative care needs. CONCLUSIONS: The NAT:PD-HF identified palliative care needs in all participants, and triggered action to address these in half. However, training in palliative care communication skills as well as palliative care interventions should accompany the introduction of a palliative care needs assessment tool. NETHERLANDS NATIONAL TRIAL REGISTER (NTR): 5616. http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5616.
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Janssen et al. (2019) studied this question.
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