title: Doctors' perceptions of palliative care for heart failure: focus group study.
abstract: OBJECTIVE
  To identify doctors' perceptions of the need for palliative care for heart failure and barriers to change.
  
  
  METHODS
  Qualitative study with focus groups.
  
  
  METHODS
  North west England.
  
  
  METHODS
  General practitioners and consultants in cardiology, geriatrics, palliative care, and general medicine.
  
  
  RESULTS
  Doctors supported the development of palliative care for patients with heart failure with the general practitioner as a central figure. They were reluctant to endorse expansion of specialist palliative care services. Barriers to developing approaches to palliative care in heart failure related to three main areas: the organisation of health care, the unpredictable course of heart failure, and the doctors' understanding of roles. The health system was thought to work against provision of holistic care, exacerbated by issues of professional rivalry and control. The priorities identified for the future were developing the role of the nurse, better community support for primary care, and enhanced communication between all the health professionals involved in the care of patients with heart failure.
  
  
  CONCLUSIONS
  Greater consideration should be given to the care of patients dying with heart failure, clarifying the roles of doctors and nurses in different specialties, and reshaping the services provided for them. Many of the organisational and professional issues are not peculiar to patients dying with heart failure, and addressing such concerns as the lack of coordination and continuity in medical care would benefit all patients.
authors.affiliation: Department of Public Health, University of Liverpool, Liverpool L69 3GB. B.Hanratty@liverpool.ac.uk
authors.forename: Barbara
authors.initials: B
authors.lastname: Hanratty
authors.forename: Derek
authors.initials: D
authors.lastname: Hibbert
authors.forename: Frances
authors.initials: F
authors.lastname: Mair
authors.forename: Carl
authors.initials: C
authors.lastname: May
authors.forename: Christopher
authors.initials: C
authors.lastname: Ward
authors.forename: Simon
authors.initials: S
authors.lastname: Capewell
authors.forename: Andrea
authors.initials: A
authors.lastname: Litva
authors.forename: Ged
authors.initials: G
authors.lastname: Corcoran
mesh_terms: D001291:Attitude of Health Personnel; D002303:Cardiac Output, Low / Q000523:psychology / Q000628:therapy*; D004739:England; D005194:Family Practice / Q000458:organization & administration*; D017144:Focus Groups; D006801:Humans; D008505:Medical Staff, Hospital / Q000523:psychology; D010166:Palliative Care / Q000458:organization & administration*; D010819:Physician's Role; D010821:Physicians, Family / Q000523:psychology*; D011364:Professional Practice; D011379:Prognosis