Barriers to goals of care discussions with hospitalized patients with advanced heart failure: feasibility and performance of a novel questionnaire

Abstract

Aims: Good end-of-life communication and decision-making are important to patients with advanced heart failure (HF) and their families, but their needs remain unmet. In this pilot study, we describe the feasibility and performance of a novel questionnaire aimed at identifying barriers and solutions to improve communication and decision-making about goals of care for hospitalized patients with advanced HF.

Methods: We distributed questionnaires to staff cardiologists, cardiology trainees, and cardiology nurses who provide care for HF patients at a Canadian teaching hospital. The questionnaire asked about the importance of various barriers to goals of care discussions. It also asked participants to rank their willingness to engage in goals of care discussions and their views on other clinicians could engage in such discussions.

Results: Of 76 clinicians, 44 (58%) completed the questionnaire (median completion time, 17 min). Individual survey questions had few missing responses (0% to 2%) for questions about barriers to goals of care discussions. There was appreciable discrimination of the importance of different barriers (mean scores 2.2 to 6.0 on a 7-point scale). Preliminary data suggest that clinicians perceive patient and family factors, such as difficulty accepting a poor prognosis, as the most important barriers preventing goals of care discussions.

Conclusions: In this pilot study, we have demonstrated the feasibility of a novel questionnaire to be used in a larger multi-centre study of end-of-life HF care. Essential information will be obtained to inform the design and evaluation of interventions that seek to improve communication and decision-making about goals of care with HF patients.

Keywords: Communication; Decision‐making; End‐of‐life care; Goals of care; Heart failure.

Figure 1

Importance of barriers to discussions about goals of care. Respondents rated the importance of various barriers to communication and decision‐making about goals of care using a 7‐point Likert scale (1 = extremely unimportant; 7 = extremely important). Abbreviations: FM = family member; LST = life sustaining therapies; ICD = implantable cardioverter defibrillator; SDM = substitute decision maker.

Figure 2

Health care professionals' willingness to engage in different aspects of communication and decision‐making about goals of care.

Figure 3

Acceptability of health care professionals to engage in different aspects of communication and decision‐making about goals of care.