title: Physicians' experiences of palliative care for heart failure patients.
abstract: BACKGROUND
  Although heart disease is the single most common cause of death knowledge about palliative care for this group of patients is deficient.
  
  
  OBJECTIVE
  The aim of this study was to describe physicians' experiences of palliative care for heart failure patients.
  
  
  METHODS
  Fifteen physicians at a medical geriatrics clinic were interviewed. The interviews were analysed using thematic content analysis.
  
  
  RESULTS
  The results show that the physicians are confronted with patients with an unpredictable disease trajectory, including patients with severe symptoms, uncertainty about anticipating the course of dying and encountering close relative's anxiety and frustration. The physicians face difficult situations regarding whether to continue or withdraw care and medical treatment which means deciding concerning 'active' medical treatment, cardio pulmonary resuscitation and an implantable cardioverter-defibrillator (ICD). The physicians acknowledge the necessity for better structured follow-ups and cooperation with outpatient settings. They recognize that there is a lack of follow-ups and continuity of care and treatment at the hospital, involving their passing on or retaining responsibility for the patients' medical care.
  
  
  CONCLUSIONS
  From the physicians' view clarification of who is principally responsible for the patient's medical care, being involved throughout the disease trajectory and cooperating more closely with palliative care services are necessary to further improve the way in which care is delivered to patients dying of heart failure.
authors.affiliation: Department of Nursing, Umeå University, Campus Skellefteå, 93187 Skellefteå, Sweden. margareta.brannstrom@nurs.umu.se
authors.forename: Margareta
authors.initials: M
authors.lastname: Brännström
authors.forename: Anna
authors.initials: A
authors.lastname: Forssell
authors.forename: Berit
authors.initials: B
authors.lastname: Pettersson
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001293:Attitude to Death; D016887:Cardiopulmonary Resuscitation / Q000523:psychology; D004417:Dyspnea / Q000523:psychology / Q000628:therapy; D004487:Edema / Q000523:psychology / Q000628:therapy; D005260:Female; D005853:Geriatrics; D006333:Heart Failure / Q000523:psychology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000523:psychology*; D010820:Physicians / Q000523:psychology*; D012720:Severity of Illness Index