In contrast to recommendations in recent guidelines, prognosis is not optimally discussed with patients with heart failure (HF). Reasons for not doing so can be related to both patient and provider characteristics.
The purpose of the study was to explore which patient- and nurse-related variables influence discussing prognosis with patients at an HF clinic.
Data from a previous survey on attitudes and clinical practice of HF nurses on discussing prognosis that was conducted in Sweden and the Netherlands were combined with data from a registration on topics that nurses discussed with their patients during a prespecified week at the HF clinic. Multivariable logistic regression analysis was performed to assess which variables are related to discussing prognosis.
A total of 275 HF nurses (mean age, 49 years) and data of 1633 patients with HF (mean age, 71 years) were included in the study. Prognosis was discussed with 42% of all patients during the visit at the HF clinic. Patients with whom prognosis was discussed were more often in New York Heart Association classes III to IV (odds ratio [OR], 1.81; 95% confidence interval [CI], 1.44–2.26). Nurses discussing prognosis reported more knowledge on the topic (OR, 1.71; 95% CI, 1.36–2.16) and discussed more topics with the patient (OR, 1.27; 95% CI, 1.21–1.32). Dutch HF nurses were more likely to discuss prognosis compared with their Swedish colleagues (OR, 1.83; 95% CI, 1.43–2.33).
Discussing prognosis with patients with HF by nurses at the HF clinic is related to the characteristics of patients and HF nurses. Future interventions to improve communications about prognosis therefore should have a broad approach.
Martje H.L. van der Wal, PhD, RN Senior Researcher, Faculty of Medical and Health Sciences, Linköping University, Norrköping, Sweden; and Department of Cardiology, University Medical Centre Groningen, University of Groningen, The Netherlands.
Lisa Hjelmfors PhD Student, Faculty of Medical and Health Sciences, Linköping University, Norrköping, Sweden.
Jan Mårtensson, PhD, RN Professor, School of Health and Welfare, Jönköping University, Sweden.
Maria Friedrichsen, PhD, RN Associate Professor, Faculty of Medical and Health Sciences, Linköping University; and Palliative Education and Research Centre in Region Östergötland, Vrinnevi Hospital, Norrköping, Sweden.
Anna Strömberg, PhD, RN Professor, Division of Nursing Science Departments of Medical and Health Science and Cardiology, Linköping University, Linköping, Sweden; and UCI Program in Nursing Science, University of California, Irvine.
Tiny Jaarsma, PhD, RN Professor, Faculty of Medical and Health Sciences, Linköping University, Norrköping, Sweden; and UCI Program in Nursing Science, University of California, Irvine; and Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
This study was funded by the Heart and Lung Foundation (number 20110417) and King Gustaf V and Queen Victoria's Foundation of the Freemasons.
The authors have no conflicts of interest to disclose.
Correspondence Martje H.L. van der Wal, PhD, RN, Faculty of Medical and Health Sciences, Linköping University, Kungsgatan 40, S-601 74 Norrköping, Sweden (firstname.lastname@example.org).