Why the study?
The study sought to identify factors influencing cardiologists' and hospitalists' decisions regarding palliative care referral for hospitalised patients with advanced heart failure.
Do specific patient and provider factors (lack of outpatient cardiologist, advance care planning, illness acceptance) increase the likelihood of palliative care referral by hospitalists and cardiologists?
Do specific patient and provider factors (lack of outpatient cardiologist, advance care planning, illness acceptance) increase the likelihood of palliative care referral by hospitalists and cardiologists?
Palliative care referral decisions for advanced heart failure patients are significantly influenced by the lack of an outpatient cardiologist, presence of advance care planning, and patient acceptance of illness severity, though most providers remain unaware of relevant guidelines.
Patient illness acceptance and ACP documentation may increase palliative referrals in advanced HF; leaves open optimal triggers and specialty roles.
OBJECTIVE: To identify factors influencing cardiologists' and hospitalists' decisions regarding palliative care referral among hospitalised patients with advanced heart failure. DESIGN: An exploratory, randomised vignette-based survey. SETTING: Cardiology and hospitalist divisions at three Michigan State institutions and the Society of Hospital Medicine's Michigan Chapter. PARTICIPANTS: 145 hospitalists and 64 cardiologists. OUTCOME MEASURES: Primary outcomes included participants' reports of their likelihood of referring a standardised patient with an acute heart failure exacerbation with multiple prior hospital admissions and acute renal failure to palliative care (scale of 0%-100%) after the initial stem and after being cued with three randomised vignette modifiers, including the presence versus the absence of continuity with an outpatient cardiologist; the presence versus the absence of documented advance care planning; and the patient voicing that he is accepting of his severe illness versus wanting everything done. Adjusted generalised linear models and predictive margins were used to evaluate the impact of each randomised modifier on referral decisions. An interaction term evaluated the effect of provider specialty on outcomes. Secondary outcomes included participants' reports of their general practices around palliative care delivery to hospitalised patients with heart failure. RESULTS: Response rate was 31.3%. Predictive margins from generalised linear models demonstrated a statistically significantly higher likelihood of referral to inpatient palliative care if the patient lacked an outpatient cardiologist (mean difference: 6.3% (95% CI 1.8% to 10.8%)); had prior advance care planning documentation (mean difference: 9.7% (95% CI 4.4% to 15.0%)); and was accepting of illness severity (mean difference: 29.6% (95% CI 24.8% to 34.4%)). No interaction effect was noted based on provider specialty. Most hospitalists and cardiologists were unaware of palliative care guidelines for patients with heart failure (74.3% vs 70.3%, p=0.71). CONCLUSIONS: A number of patient and provider factors influence palliative care referral decisions in hospitalised patients with advanced heart failure.
No takes yet. Share an insight, caveat, or question.
Abedini et al. (2020) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: