title: Advanced heart failure: prognosis, uncertainty, and decision making.
abstract: Heart failure is a serious clinical management challenge for both patients and primary care physicians. The authors studied the perceptions and practices of internal medicine residents and faculty at an academic medical center in the Southeast to guide design of strategies to improve heart failure care. Data were collected via a self-administered survey. Eighty-nine faculty and resident physicians in general internal medicine and geriatrics participated (74% response rate). Items measured perceived skills and barriers, adherence to guidelines, and physician understanding of patient prognosis. Case studies explored practice approaches. Clinical knowledge and related scales were generally good and comparable between physician groups. Palliative care and prognostic skills were self-rated with wide variance. Physicians rated patient noncompliance and low lifestyle change motivation as major barriers. Given the complexities of caring for elderly persons with heart failure and comorbid conditions, there are significant opportunities for improving physician skills in decision making, patient-centered counseling, and palliative care.
authors.affiliation: Department of Biostatistics, Bioinformatics, and Epidemiology, Medical University of South Carolina, Charleston, SC 29425, USA. zapka@musc.edu
authors.forename: Jane G
authors.initials: JG
authors.lastname: Zapka
authors.forename: William P
authors.initials: WP
authors.lastname: Moran
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Goodlin
authors.forename: Kelly
authors.initials: K
authors.lastname: Knott
mesh_terms: D000368:Aged; D003657:Decision Making; D018450:Disease Progression; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D018802:Patient-Centered Care; D010820:Physicians; D011379:Prognosis; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome