Only 12 Percent of Doctors, Assistants Follow
End-of-Life Discussion Guidelines
Doctors, nurse practitioners and physician assistants
have long list of reasons they skip end-of-life care in counseling heart
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June 4, 2014 - Healthcare providers are reluctant
to discuss end-of-life care with heart failure patients and their
families because they feel uncomfortable broaching the topic or lack
time, according to a new study presented this morning at the Quality of
Care and Outcomes Research 2014 Scientific Sessions.
Researchers surveyed 50 physicians and 45 nurse
practitioners or physician assistants at three practices at the Mayo
Clinic in Rochester, Minnesota and the Mayo Clinic Health System.
Ninety-five clinicians completed the survey.
Among the findings:
Only 12 percent of the healthcare
providers reported having routine yearly discussions about
end-of-life care as advocated by the American Heart Association.
Thirty percent of the group
reported having little confidence in discussing or providing
Among the 52 percent who said
they felt hesitant mentioning end-of-life-care, 21 percent cited
their perceptions that patients weren’t ready to talk about the
issue; 11 percent said they felt uncomfortable bringing it up; 9
percent said they worried about destroying a sense of hope; and 8
percent said they lacked time.
Healthcare providers were often unsure about who should bring up
end-of-life care: 63 percent of
heart failure specialists and 58 percent of community cardiology
clinicians thought end-of-life care discussions were the responsibility
of heart failure cardiologists, while 66 percent of primary care
providers felt it was their responsibility.
these perceptions, heart failure specialists and community cardiology
clinicians were far more likely to have referred heart failure patients
palliative care within the past year than primary care physicians
(89 percent versus 21 percent).
“Providers did express an interest in receiving additional training to
develop the skills and confidence to talk about end-of-life care with
their patients with heart failure,” said Shannon Dunlay, M.D., M.S., the
study’s lead researcher and a cardiologist at the Mayo Clinic in
no evidence that bringing up end-of-life care ruins hope, and it may
ease anxiety for some patients and families, Dunlay said.
million Americans have heart failure and about half of those die within
five years of their diagnosis, according to American Heart Association
“Communication is key, but in many hospitals and health systems this can
be difficult as patients often have multiple healthcare providers,”
“Sometimes it’s helpful to pick up the phone and have a
provider-to-provider conversation so that everybody is on the same
page. Incorporating end-of-life conversations into the ongoing, routine
care of the patient is important as goals and preferences can change
over time and patients and their families can feel more comfortable and
confident in relaying their wishes to multiple providers.”
Co-authors are Jilian L. Foxen, M.Ed.; Terese Cole, R.N., C.N.P.; Molly
A. Feely, M.D.; Ann R. Loth, R.N., C.N.S.; Jacob J. Strand, M.D.; Keith
M. Swetz, M.D., M.A.; Jean A. Wagner, M.S., C.N.P.; and Margaret M.
Redfield, M.D. Author disclosures are on the abstract.
National Institutes of Health Career Development Award helped fund the