title: Barriers and Facilitators to Palliative Care of Patients with Chronic Heart Failure in Germany: A Study Protocol.
abstract: BACKGROUND
  Despite its high prevalence, similar symptoms and symptom burden, people suffering from chronic heart failure receive less palliative care than patients with malignant diseases. Internationally, numerous barriers to palliative care of patients with chronic heart failure are known, however, there are no credible data regarding barriers and facilitators to palliative care of people suffering from chronic heart failure available for Germany.
  
  
  METHODS
  Tripartite study. First part of this study evaluates health care providers' (physicians and nurses) perceived barriers and facilitators to palliative care of patients with chronic heart failure using a qualitative approach. At least 18 persons will be interviewed. In the second part, based on the results of part one, a questionnaire about barriers and facilitators to palliative care of patients with chronic heart failure will be designed and applied to at least 150 physicians and nurses. In the last part a classic Delphi method will be used to develop specific measures to improve the palliative care for chronic heart failure patients.
  The results of this study will help to understand why patients with heart failure are seldom referred to palliative care and will provide solutions to overcome these barriers. Developed solutions will be the first step to improve palliative care in patients with heart failure in Germany. In addition, the results will help health care providers in other countries to take action to improve palliative care situations for heart failure patients. Significance for public healthPatients with chronic heart failure suffer from similar symptoms and symptom burden than patients with malignant diseases. However, palliative care differs between these groups in a quantitative and qualitative way. This study will help to understand why patients with chronic heart failure receive less palliative care than patients with malignant disease. In addition, measures to overcome barriers and to promote facilitators of palliative care in patients with chronic heart failure will be developed. These recommendations could provide a basis for quality improvement projects or studies aiming at improving symptoms and symptom burden of heart failure patients. The recommended measures could also be used to reduce caregiver burden.
authors.affiliation: Institute for Quality Management and Social Medicine, Medical Centre - University of Freiburg , Germany ; Heart Centre, University of Freiburg , Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Köberich
authors.affiliation: Institute for Quality Management and Social Medicine, Medical Centre - University of Freiburg , Germany.
authors.forename: Jeantte
authors.initials: J
authors.lastname: Ziehm
authors.affiliation: Institute for Quality Management and Social Medicine, Medical Centre - University of Freiburg , Germany.
authors.forename: Erik
authors.initials: E
authors.lastname: Farin
authors.affiliation: Department of Palliative Care, Medical Centre, University of Freiburg , Germany.
authors.forename: Gerhild
authors.initials: G
authors.lastname: Becker
keywords: Palliative care; attitudes; experiences; health care professionals; heart failure