title: Patient-Nurse Communication about Prognosis and End-of-Life Care.
abstract: BACKGROUND
  Although several studies advise that discussions about prognosis and end-of-life care should be held throughout the whole heart failure (HF) trajectory, data is lacking on the prevalence and practice of such discussions in HF care.
  
  
  OBJECTIVE
  The study objective was to explore how often and why HF nurses in outpatient clinics discuss prognosis and end-of-life care in the context of patient education.
  
  
  METHODS
  This was a descriptive and comparative study. Participants were HF nurses from Swedish and Dutch HF outpatient clinics. Measurements were taken via a survey for both quantitative and qualitative data. Additional data was collected via open-ended questions and analyzed with content analysis.
  
  
  RESULTS
  Two hundred seventy-nine nurses registered 1809 patient conversations using a checklist. Prognosis and end-of-life care were among the least frequently discussed topics, whereas symptoms of HF was discussed most often. Prognosis was discussed with 687 patients (38%), and end-of-life care was discussed with 179 patients (10%). Prognosis and end-of-life care were discussed more frequently in The Netherlands than in Sweden (41% versus 34%, p<0.001, 13% versus 4%, p<0.001). The nurses did not always recognize prognosis and end-of-life care discussions as a part of their professional role.
  
  
  CONCLUSIONS
  Currently, patient-nurse communication about prognosis and end-of-life care does not seem to be routine in patient education in HF clinics, and these discussions could be included more often. The reasons for nurses to discuss these topics were related to clinical routines, the patient's situation, and professional responsibilities. To improve future care, communication with patients needs to be further developed.
authors.affiliation: 1 Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University , Linköping, Sweden .
authors.forename: Lisa
authors.initials: L
authors.lastname: Hjelmfors
authors.affiliation: 1 Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University , Linköping, Sweden .|2 Department of Cardiology, University of Groningen, University Medical Center Groningen , Groningen, the Netherlands .
authors.forename: Martje H L
authors.initials: MH
authors.lastname: van der Wal
authors.affiliation: 1 Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University , Linköping, Sweden .
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Friedrichsen
authors.affiliation: 3 Department of Nursing, School of Health Sciences, Jönköping University , Jönköping, Sweden .
authors.forename: Jan
authors.initials: J
authors.lastname: Mårtensson
authors.affiliation: 4 Department of Medical and Health Sciences, Division of Nursing, Faculty of Health Sciences and Department of Cardiology, Linköping University , Linköping, Sweden .
authors.forename: Anna
authors.initials: A
authors.lastname: Strömberg
authors.affiliation: 1 Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University , Linköping, Sweden .
authors.forename: Tiny
authors.initials: T
authors.lastname: Jaarsma
mesh_terms: D000368:Aged; D001291:Attitude of Health Personnel; D003142:Communication; D015897:Comorbidity; D003431:Cross-Cultural Comparison; D005260:Female; D019538:Health Care Surveys; D006333:Heart Failure / Q000451:nursing*; D006801:Humans; D008297:Male; D009426:Netherlands; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D010044:Outpatient Clinics, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D010353:Patient Education as Topic / Q000592:standards* / Q000706:statistics & numerical data; D011379:Prognosis; D013548:Sweden; D013727:Terminal Care / Q000379:methods / Q000523:psychology* / Q000592:standards