title: A survey of clinician attitudes and self-reported practices regarding end-of-life care in heart failure.
abstract: BACKGROUND
  As heart failure often follows an unpredictable clinical trajectory, there has been an impetus to promote iterative patient-provider discussions regarding prognosis and preferences for end-of-life care.
  
  
  OBJECTIVE
  To examine clinicians' practices, expectations, and personal level of confidence in discussing goals of care and providing end-of-life care to their patients with heart failure.
  
  
  METHODS
  Multi-site clinician survey.
  
  
  METHODS
  Physicians, nurse practitioners, and physician assistants at Mayo Clinic (Rochester, Minnesota, USA) and its surrounding health system were asked to participate in an electronic survey in October 2013. Tertiary Care Cardiology, Community Cardiology, and Primary Care clinicians were surveyed.
  
  
  RESULTS
  A total of 95 clinicians participated (52.5% response rate). Only 12% of clinicians reported having annual end-of-life discussions as advocated by the American Heart Association. In total, 52% of clinicians hesitated to discuss end-of-life care citing provider discomfort (11%), perception of patient (21%) or family (12%) unreadiness, fear of destroying hope (9%), or lack of time (8%). Tertiary and Community Cardiology clinicians (66%) attributed responsibility for end-of-life discussions to the heart failure cardiologist, while 66% of Primary Care clinicians felt it was their responsibility. Overall, 30% of clinicians reported a low or very low level of confidence in one or more of the following: initiating prognosis or end-of-life discussions, enrolling patients in hospice, or providing end-of-life care. Most clinicians expressed interest in further skills acquisition.
  
  
  CONCLUSIONS
  Clinicians vary in their views and approaches to end-of-life discussions and care. Some lack confidence and most are interested in further skills acquisition.
authors.affiliation: Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA Dunlay.Shannon@mayo.edu.
authors.forename: Shannon M
authors.initials: SM
authors.lastname: Dunlay
authors.affiliation: Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Jilian L
authors.initials: JL
authors.lastname: Foxen
authors.affiliation: Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Terese
authors.initials: T
authors.lastname: Cole
authors.affiliation: Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Molly A
authors.initials: MA
authors.lastname: Feely
authors.affiliation: Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Ann R
authors.initials: AR
authors.lastname: Loth
authors.affiliation: Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Jacob J
authors.initials: JJ
authors.lastname: Strand
authors.affiliation: Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Jean A
authors.initials: JA
authors.lastname: Wagner
authors.affiliation: Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Keith M
authors.initials: KM
authors.lastname: Swetz
authors.affiliation: Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Redfield
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003142:Communication; D005260:Female; D006333:Heart Failure / Q000451:nursing / Q000628:therapy*; D017051:Hospice Care / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000706:statistics & numerical data*; D057184:Practice Patterns, Nurses'; D010818:Practice Patterns, Physicians'; D011369:Professional-Patient Relations; D020377:Self Efficacy; D057566:Self Report; D013727:Terminal Care / Q000706:statistics & numerical data*; D014481:United States
keywords: Heart failure; discussions; end-of-life; prognosis