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Ahead of this morning’s symposium, Doctor Loreena Hill (Queen’s University, Belfast, UK) and Professor Tiny Jaarsma (Linköping University, Linköping, Sweden), Coordinator and Co-Coordinator, respectively, of the Palliative Care Taskforce of the Heart Failure Association, discuss the importance of integrating multidisciplinary team treatment decisions with patients’ wishes in advanced heart failure.
Dr. Hill says that a change of focus from a curative to a more palliative approach should be more readily accepted by the multidisciplinary team when there is continual and irreversible deterioration in signs and symptoms indicating treatment options are becoming limited. “However,” she explains, “the central players in the decision should always be the patient and their family. Many heart failure patients remain optimistic about the potential length of life left to live. This dilemma is made more complex by the introduction of new advanced devices and surgical interventions. But at some point, the team along with the patient and their family should prioritise quality of life as a management goal.” Previously, care of heart failure patients at this stage would have been ‘handed over’ to the specialist palliative care team. “Currently,” says Dr. Hill, “the move is towards a shared-care process involving all team members, integrating specialisms and disciplines including allied professionals, providing seamless care extending across the different centres at which the patient is treated.”
Communication with patients and their families is extremely important in late-stage disease, says Prof. Jaarsma. “In cardiology, we are not used to talking about dying. Doctors and nurses do not want to take away hope and may try to avoid these conversations. But most patients will eventually want to know what the future holds and we need to be honest with them and provide support.” Prof. Jaarsma recognises that it is not easy to know when to have these conversations. “It is often the elephant in the room. Patients might want to ask but are afraid to hear the answer,” she says. “To help patients take the initial step, our team developed a prompt list that patients can hand to their healthcare professional indicating issues they would like to discuss. Every team member should learn good communication skills because the subject could arise at any patient visit and we all need to be prepared to handle it empathetically.”
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Management of advanced heart failure and end of life patients – A team approach14:30 – 15:40; Sarajevo – Village 5
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