title: The gap between policy and practice: a systematic review of patient-centred care interventions in chronic heart failure.
abstract: Patient-centred care (PCC) is recommended in policy documents for chronic heart failure (CHF) service provision, yet it lacks an agreed definition. A systematic review was conducted to identify PCC interventions in CHF and to describe the PCC domains and outcomes. Medline, Embase, CINAHL, PsycINFO, ASSIA, the Cochrane database, clinicaltrials.gov, key journals and citations were searched for original studies on patients with CHF staged II-IV using the New York Heart Association (NYHA) classification. Included interventions actively supported patients to play informed, active roles in decision-making about their goals of care. Search terms included 'patient-centred care', 'quality of life' and 'shared decision making'. Of 13,944 screened citations, 15 articles regarding 10 studies were included involving 2540 CHF patients. Three studies were randomised controlled trials, and seven were non-randomised studies. PCC interventions focused on collaborative goal setting between patients and healthcare professionals regarding immediate clinical choices and future care. Core domains included healthcare professional-patient collaboration, identification of patient preferences, patient-identified goals and patient motivation. While the strength of evidence is poor, PCC has been shown to reduce symptom burden, improve health-related quality of life, reduce readmission rates and enhance patient engagement for patients with CHF. There is a small but growing body of evidence, which demonstrates the benefits of a PCC approach to care for CHF patients. Research is needed to identify the key components of effective PCC interventions before being able to deliver on policy recommendations.
authors.affiliation: King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, UK. pauline.m.kane@kcl.ac.uk.
authors.forename: P M
authors.initials: PM
authors.lastname: Kane
authors.affiliation: King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, UK.
authors.forename: F E M
authors.initials: FE
authors.lastname: Murtagh
authors.affiliation: St. Francis Hospice, Dublin, Ireland.|Mater Misericordiae University Hospital, Dublin, Ireland.
authors.forename: K
authors.initials: K
authors.lastname: Ryan
authors.affiliation: Mater Misericordiae University Hospital, Dublin, Ireland.
authors.forename: N G
authors.initials: NG
authors.lastname: Mahon
authors.affiliation: Beaumont Hospital, Dublin, Ireland.
authors.forename: B
authors.initials: B
authors.lastname: McAdam
authors.affiliation: St. Francis Hospice, Dublin, Ireland.|Beaumont Hospital, Dublin, Ireland.
authors.forename: R
authors.initials: R
authors.lastname: McQuillan
authors.affiliation: King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, UK.
authors.forename: C
authors.initials: C
authors.lastname: Ellis-Smith
authors.affiliation: Mater Misericordiae University Hospital, Dublin, Ireland.
authors.forename: C
authors.initials: C
authors.lastname: Tracey
authors.affiliation: Mater Misericordiae University Hospital, Dublin, Ireland.
authors.forename: C
authors.initials: C
authors.lastname: Howley
authors.affiliation: Beaumont Hospital, Dublin, Ireland.
authors.forename: C
authors.initials: C
authors.lastname: Raleigh
authors.affiliation: Beaumont Hospital, Dublin, Ireland.
authors.forename: G
authors.initials: G
authors.lastname: O'Gara
authors.affiliation: King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, UK.
authors.forename: I J
authors.initials: IJ
authors.lastname: Higginson
authors.affiliation: King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, UK.
authors.forename: B A
authors.initials: BA
authors.lastname: Daveson
mesh_terms: D002908:Chronic Disease; D003657:Decision Making; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D018802:Patient-Centered Care / Q000331:legislation & jurisprudence*; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic
keywords: Heart failure; Palliative care; Patient-centred care; Shared decision-making; Systematic review