Integrated, collaborative palliative care in heart failure: the St. George Heart Failure Service experience 1999-2002.
BACKGROUND
Chronic heart failure (HF) is the only heart condition increasing in prevalence and is primarily a condition of aging. This condition has outcomes worse than many cancers; however, patients are often denied the benefits of palliative care with its important emphasis on symptom management, spirituality, and emotional health and focus on family issues.


OBJECTIVE
To describe the development of a model of an integrated, consultative, palliative care approach within a comprehensive HF community-focussed disease management program.


METHODS
A collaborative model was developed following a systematic needs assessment and documentation of local resources. Principles underpinning this model were based upon fostering of communication, consultancy, and skill development. Within this model a health care system, based upon universal coverage, supported co-management of patients and their families. The place of death, level of social support available at home, and degree of palliative care involvement was documented in 121 consecutive deaths from 1999-2002.


RESULTS
Following a period of skill sharing and program development, only 8.3% of HF patients in the collaborative program required specialized palliative care intervention for complex symptom management, carer support, and issues related to spirituality. Twenty percent of this cohort died in nursing homes underscoring the importance of supporting our nursing colleagues in this setting.


CONCLUSIONS
In spite of well-documented difficulties in determining prognosis, it is the St George experience that key principles of a palliative care strategy can be implemented in a HF disease management program with support and consultancy from expert palliative care services.
School of Nursing, Family and Community Health, University of Western Sydney, & Western Sydney Area Health Service, Sydney, Australia. patricia_davidson@wsahs.nsw.gov.au
Patricia M
PM
Davidson
Glenn
G
Paull
Kate
K
Introna
Jill
J
Cockburn
Jan Maree
JM
Davis
David
D
Rees
David
D
Gorman
Linda
L
Magann
Mary
M
Lafferty
Kathleen
K
Dracup
D003153:Community Health Services / Q000458:organization & administration*; D003266:Continuity of Patient Care / Q000458:organization & administration; D003299:Cooperative Behavior; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D019468:Disease Management; D006302:Health Services Research; D006333:Heart Failure / Q000453:epidemiology / Q000628:therapy*; D006746:Hospital Bed Capacity, 500 and over; D006784:Hospitals, Teaching / Q000458:organization & administration*; D006801:Humans; D007373:Interinstitutional Relations; D017146:Models, Organizational; D020380:Needs Assessment; D009517:New South Wales; D009720:Nurse Clinicians / Q000458:organization & administration; D010166:Palliative Care / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration; D024382:Professional Role; D016730:Program Development; D015397:Program Evaluation; D017749:Total Quality Management / Q000458:organization & administration