Chronic heart failure (HF) is the only heart condition increasing in prevalence and is primarily a condition of aging. This condition has outcomes worse than many cancers; however, patients are often denied the benefits of palliative care with its important emphasis on symptom management, spirituality, and emotional health and focus on family issues.
To describe the development of a model of an integrated, consultative, palliative care approach within a comprehensive HF community-focussed disease management program.
A collaborative model was developed following a systematic needs assessment and documentation of local resources. Principles underpinning this model were based upon fostering of communication, consultancy, and skill development. Within this model a health care system, based upon universal coverage, supported co-management of patients and their families. The place of death, level of social support available at home, and degree of palliative care involvement was documented in 121 consecutive deaths from 1999–2002.
Following a period of skill sharing and program development, only 8.3% of HF patients in the collaborative program required specialized palliative care intervention for complex symptom management, carer support, and issues related to spirituality. Twenty percent of this cohort died in nursing homes underscoring the importance of supporting our nursing colleagues in this setting.
In spite of well-documented difficulties in determining prognosis, it is the St George experience that key principles of a palliative care strategy can be implemented in a HF disease management program with support and consultancy from expert palliative care services.
Patricia M. Davidson, RN, BA, MEd, PhD, MCRNA Associate Clinical Professor of Nursing, School of Nursing, Family and Community Health, University of Western Sydney, & Western Sydney Area Health Service, Sydney, Australia.
Glenn Paull, RN, BN (Hons) Clinical Nurse Consultant (Heart Failure), Cardiology Department, The St. George Hospital, Sydney, Australia.
Kate Introna, RN, RM, Grad Dip Nsg (Palliative Care) Clinical Nurse Consultant (Palliative Care), Division of Cancer and Community Services, The St. George Hospital, Sydney, Australia.
Jill Cockburn, MSc, PhD Discipline of Behavioural Sciences in Relation to Medicine, Faculty of Medicine & Health Sciences, The University of Newcastle, Newcastle, Australia.
Jan Maree Davis, B. Med (Hons), FRACP Palliative Care Physician, Division of Cancer and Community Services, Calvary Hospital/The St George Hospital, Sydney, Australia.
David Rees, MBBS, FRACP, PhD Director of Coronary Care, Cardiology Department, The St. George Hospital, Sydney, Australia.
David Gorman, MBBS, FRACP, LLB Palliative Care Physician, The St. George Hospital/Calvary Hospital, Sydney, Australia.
Linda Magann, RN, Grad Dip Nurs Man, Cert Pall Care, Cert Oncology Clinical Nurse Consultant, Division of Cancer and Community Services, The St. George Hospital, Sydney, Australia.
Mary Lafferty, RN, Grad Dip Community, Grad Cert Pall Care Clinical Nurse Consultant, Palliative Care, Calvary Health Care, Sydney, Australia.
Kathleen Dracup, RN, FNP, CNS, DNSc, FAAN Dean and Professor, UCSF School of Nursing N319C, University of California, San Francisco, San Francisco.
Corresponding author Patricia M. Davidson, RN, BA, MEd, MCRNA, School of Nursing, Family and Community Health, University of Western Sydney, PO Box 1797, Penrith DC 1797, Sydney, Australia (e-mail: firstname.lastname@example.org).