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Designing and Testing an End-of-Life Discussion Intervention for African American Patients With Heart Failure and Their Families

Piamjariyakul, Ubolrat PhD, RN; Smith, Carol E. PhD, RN, FAAN; Werkowitch, Marilyn BSN, RN; Thompson, Noreen MSN, RN; Fox, Maria DNP, APRN-CNS, ACHPN, CCRN; Williamson, Karin Porter MD, FAAHPM; Olson, Lori MD

Journal of Hospice & Palliative Nursing: December 2016 - Volume 18 - Issue 6 - p 528–535
doi: 10.1097/NJH.0000000000000290
Feature Articles

There is an escalating prevalence of heart failure (HF) with high mortality. Compared with other races, African Americans face a higher incidence of HF at earlier age of onset, with more rapid progression, and with increased family care burden and greater care costs and disparity in health care services at the end of life (EOL). Concomitant out-of-pocket HF costs and care demands indicate the need for early discussion of palliative and EOL care needs. We therefore developed and pilot tested a culturally sensitive intervention specific to the needs of African American HF patients and their families at the EOL. Our pilot study findings encompass patient and caregiver perspectives and align with the state of EOL science. The ultimate long-term goal of this intervention strategy is to translate into practice the preferred, culturally sensitive, and most cost-efficient EOL care recommendations for HF patients and families.

Ubolrat Piamjariyakul, PhD, RN, is research associate professor, School of Nursing, University of Kansas Medical Center.

Carol E. Smith, PhD, RN, FAAN, is professor, School of Nursing and Preventive Medicine & Public Health, University of Kansas Medical Center.

Marilyn Werkowitch, BSN, RN, is research assistant, School of Nursing, University of Kansas Medical Center.

Noreen Thompson, MSN, RN, is psychiatric nurse specialist, Department of Nursing Clinical Excellence, University of Kansas Medical Center.

Maria Fox, DNP, APRN-CNS, ACHPN, CCRN, is director, Advanced Practice Professionals, University of Kansas Health System.

Karin Porter Williamson, MD, FAAHPM, is associate professor and senior scientist, Palliative Medicine, University of Kansas Medical Center.

Lori Olson, MD, is assistant professor and senior scientist, Internal Medicine, University of Kansas Medical Center.

Address correspondence to Ubolrat Piamjariyakul, PhD, RN, West Virginia University, School of Nursing, Health Sciences Center, Post Office Box 9600 - Office 6414A, Morgantown, WV 26506-9602 (

The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the hospitals or departments mentioned.

The authors have no conflicts of interest to disclose.

© 2016 by The Hospice and Palliative Nurses Association.