Exploring the Role of Palliative Care in Heart Failure: Referral Barriers, Care Gaps, and Quality of Care Public Deposited

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  • March 19, 2019
Creator
  • Kavalieratos, Dio
    • Affiliation: Gillings School of Global Public Health, Department of Health Policy and Management
Abstract
  • Heart failure is a chronic, incurable disease that presents significant burdens to patients, caregivers, and the healthcare system. With approximately 5 million Americans currently diagnosed with heart failure, the effective management of heart failure patients is of prime interest to clinicians, policymakers, and payers. Palliative care, which has been shown to improve patient outcomes in cancer, may hold similar promise for heart failure patients. However, despite similar disease experiences and prognosis, heart failure patients are less likely to receive palliative care than cancer patients. This dissertation investigates the current and potential role of specialist palliative care in heart failure. Through the use of mixed qualitative and quantitative methodologies, the three papers in this dissertation provide contributions to the medical literature related to: (1) palliative care referral barriers in heart failure; (2) the unresolved symptoms and treatment gaps of heart failure patients prior to palliative care consultation; and, (3) the link between palliative processes and patient outcomes in a cohort of heart failure patients receiving community-based palliative care. Our findings suggest that the term palliative care is ambiguous to providers and itself may stand as a barrier to referral. Nevertheless, we documented agreement among primary care, cardiology, and palliative care providers regarding the likely potential benefit of palliative services in advanced heart failure. Next, we found that among a group of heart failure and cancer patients receiving palliative care, both groups possessed significant palliative needs. Furthermore, the profiles of burden were not strikingly different between disease groups, thereby suggesting that the need for palliative care is similar for patients living with either illness. Lastly, we present data regarding the impact of palliative care in a cohort of heart failure patients. Of five quality indicators, the completion of a comprehensive assessment was found to be associated with improved patient health. In sum, this dissertation provides a glimpse into the needs of HF patients and how they might be addressed by specialist palliative care. Our work suggests that in heart failure, palliative care is underutilized, that patients have unmet needs, and that specific palliative interventions such as comprehensive assessment should be prioritized.
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  • In Copyright
Advisor
  • Weinberger, Morris
Degree
  • Doctor of Philosophy
Graduation year
  • 2012
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