Key result
In 39 qualitative interviews, trust, understanding of hospice, and family support emerged as key themes shaping goals of care conversations for heart failure patients in home hospice.
Why the study?
Despite most hospice care occurring at home, gaps remain in understanding how to facilitate goals of care conversations between heart failure patients and healthcare providers.
Improving goals of care conversations in home hospice for heart failure patients requires building trust, promoting hospice understanding, and engaging family support.
These themes may inform trust-building interventions in HF hospice; hypothesis-generating and requires prospective trials before practice change.
BACKGROUND: Despite a majority of persons receiving hospice care in their homes, there are gaps in understanding how to facilitate goals of care conversations between persons with heart failure and healthcare providers. AIM: To identify barriers and facilitators which shape goals of care conversations for persons with heart failure in the context of home hospice. DESIGN: A qualitative descriptive study design was used with semi-structured interviews. SETTING/PARTICIPANTS: We conducted qualitative interviews with persons with heart failure, family caregivers, and interprofessional healthcare team members at a large not-for-profit hospice agency in New York City between March 2018 and February 2019. RESULTS: A total of 39 qualitative interviews were conducted, including with healthcare team members (e.g. nurses, physicians, social workers, spiritual counselors), persons with heart failure, and family caregivers. Three themes emerged from the qualitative interviews regarding facilitators and barriers in goals of care conversations for better decision-making: (1) trust is key to building and maintaining goals of care conversations; (2) lack of understanding and acceptance of hospice inhibits goals of care conversations; and (3) family support and engagement promote goals of care conversations. CONCLUSION: Findings from this study suggest that interventions designed to improve goals of care conversations in the home hospice setting should focus on promoting understanding and acceptance of hospice, family support and engagement, and building trusting relationships with interprofessional healthcare teams.
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Baik et al. (2020) studied Heart failure (n=39). Goals of care conversations was evaluated on Barriers and facilitators shaping goals of care conversations. In 39 qualitative interviews, trust, understanding of hospice, and family support emerged as key themes shaping goals of care conversations for heart failure patients in home hospice.
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