title: Unique challenges of hospice for patients with heart failure: A qualitative study of hospice clinicians.
abstract: BACKGROUND
  Patients with heart failure have end-of-life care needs that may benefit from hospice care. The goal of this descriptive study was to understand hospice clinicians' perspectives on the unique aspects of caring for patients with heart failure to inform approaches to improving end-of-life care.
  
  
  METHODS
  This qualitative study explored experiences, observations, and perspectives of hospice clinicians regarding hospice care for patients with heart failure. Thirteen hospice clinicians from a variety of professional disciplines and clinical roles, diverse geographic regions, and varying lengths of time working in hospice participated in semistructured interviews. Through team-based, iterative qualitative analysis, we identified 3 major themes.
  
  
  RESULTS
  Hospice clinicians identified 3 themes regarding care for patients with heart failure. First, care for patients with heart failure involves clinical complexity and a tailored approach to cardiac medications and advanced cardiac technologies. Second, hospice clinicians describe the difficulty patients with heart failure have in trusting hospice care due to patient optimism, prognostic uncertainty, and reliance on prehospice health care providers. Third, hospice clinicians described opportunities to improve heart failure-specific hospice care, highlighting the desire for collaboration with referring cardiologists.
  
  
  CONCLUSIONS
  From a hospice clinician perspective, caring for patients with heart failure is unique compared with other hospice populations. This study suggests potential opportunities for hospice clinicians and referring providers who seek to collaborate to improve care for patients with heart failure during the transition to hospice care.
authors.affiliation: University of Colorado School of Medicine, Aurora, CO; Veterans Affairs Eastern Colorado Health Care System, Denver, CO. Electronic address: Hillary.Lum@ucdenver.edu.
authors.forename: Hillary D
authors.initials: HD
authors.lastname: Lum
authors.affiliation: University of Colorado School of Nursing, Aurora, CO.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Jones
authors.affiliation: University of Colorado School of Medicine, Aurora, CO.
authors.forename: Dana
authors.initials: D
authors.lastname: Lahoff
authors.affiliation: University of Colorado School of Medicine, Aurora, CO; Colorado Cardiovascular Outcomes Research Consortium, Denver, CO.
authors.forename: Larry A
authors.initials: LA
authors.lastname: Allen
authors.affiliation: University of Colorado School of Medicine, Aurora, CO; Veterans Affairs Eastern Colorado Health Care System, Denver, CO; Colorado Cardiovascular Outcomes Research Consortium, Denver, CO.
authors.forename: David B
authors.initials: DB
authors.lastname: Bekelman
authors.affiliation: University of Colorado School of Medicine, Aurora, CO.
authors.forename: Jean S
authors.initials: JS
authors.lastname: Kutner
authors.affiliation: University of Colorado School of Medicine, Aurora, CO; Colorado Cardiovascular Outcomes Research Consortium, Denver, CO.
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Matlock
mesh_terms: D000368:Aged; D003120:Colorado; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006738:Hospices / Q000592:standards*; D006801:Humans; D008297:Male; D009726:Nurses / Q000592:standards*; D010820:Physicians / Q000592:standards*; D011379:Prognosis; D011785:Quality Assurance, Health Care; D013727:Terminal Care / Q000592:standards*; D000078329:Workforce