title: Psychological, social and spiritual distress at the end of life in heart failure patients.
abstract: OBJECTIVE
  Chronic heart failure patients have palliative care needs that include psychosocial and spiritual support, particularly towards the end of life, when breathlessness and resultant immobility become increasingly severe. This review informs clinicians of the importance of understanding, assessing and managing patients' psychosocial and spiritual needs.
  
  
  RESULTS
  The high prevalence of depression (9-77.5%) among chronic heart failure patients is well documented. Clinical assessment and treatment of depression and anxiety are key to good patient care, although no model for assessment has been agreed. Evidence suggests that social support and spiritual belief are important coping resources, but there is a dearth of research into social and spiritual distress in chronic heart failure. Patients rarely access social services support, and family carers experience considerable burden. Little is known about how psychosocial and spiritual variables influence each other, and the impact of social and spiritual distress on outcomes such as quality of life.
  
  
  CONCLUSIONS
  We hope this review will inform cardiac and palliative care staff about the prevalence of psychosocial and spiritual distress in advanced chronic heart failure, and highlight the importance of their assessment and management. There is an urgent need for research in this field, including the rigorous development and evaluation of service models and nonpharmacological interventions.
authors.affiliation: Department of Palliative Care, Policy & Rehabilitation, King's College London, UK. lucy.selman@kcl.ac.uk
authors.forename: Lucy
authors.initials: L
authors.lastname: Selman
authors.forename: Teresa
authors.initials: T
authors.lastname: Beynon
authors.forename: Irene J
authors.initials: IJ
authors.lastname: Higginson
authors.forename: Richard
authors.initials: R
authors.lastname: Harding
mesh_terms: D006333:Heart Failure / Q000523:psychology* / Q000628:therapy*; D006801:Humans; D010166:Palliative Care / Q000379:methods*; D012944:Social Support; D029181:Spirituality