Among 19 European guidelines and pathways for advanced heart failure and COPD, 18 focused on suffering reduction and 13 recommended a holistic approach, indicating growing awareness but a lack of standardized referral criteria and end-of-life care strategies.
Systematic Review (n=19)
There is growing awareness of the importance of integrated palliative care in advanced CHF and COPD, but standardized strategies are needed to alleviate existing barriers.
BACKGROUND: Despite the positive impact of Palliative Care (PC) on the quality of life for patients and their relatives, the implementation of PC in non-cancer health-care delivery in the EU seems scarcely addressed. The aim of this study is to assess guidelines/pathways for integrated PC in patients with advanced Chronic Heart Failure (CHF) and Chronic Obstructive Pulmonary Disease (COPD) in Europe via a systematic literature review. METHODS: Search results were screened by two reviewers. Eligible studies of adult patients with CHF or COPD published between 01/01/1995 and 31/12/2013 in Europe in 6 languages were included. Nine electronic databases were searched, 6 journals were hand-searched and citation tracking was also performed. For the analysis, a narrative synthesis was employed. RESULTS: The search strategy revealed 26,256 studies without duplicates. From these, 19 studies were included in the review; 17 guidelines and 2 pathways. 18 out of 19 focused on suffering reduction interventions, 13/19 on a holistic approach and 15/19 on discussions of illness prognosis and limitations. The involvement of a PC team was mentioned in 13/19 studies, the assessment of the patients' goals of care in 12/19 and the advance care planning in 11/19. Only 4/19 studies elaborated on aspects such as grief and bereavement care, 7/19 on treatment in the last hours of life and 8/19 on the continuation of goal adjustment. CONCLUSION: The results illustrate that there is a growing awareness for the importance of integrated PC in patients with advanced CHF or COPD. At the same time, however, they signal the need for the development of standardized strategies so that existing barriers are alleviated.
Siouta et al. (2016) conducted a systematic review in Advanced Chronic Heart Failure and Chronic Obstructive Pulmonary Disease (n=19). Integrated palliative care guidelines and pathways was evaluated on Proportion of guidelines addressing specific Integrated Palliative Care (IPC) criteria. Among 19 European guidelines and pathways for advanced heart failure and COPD, 18 focused on suffering reduction and 13 recommended a holistic approach, indicating growing awareness but a lack of standardized referral criteria and end-of-life care strategies.