title: Towards integration of palliative care in patients with chronic heart failure and chronic obstructive pulmonary disease: a systematic literature review of European guidelines and pathways.
abstract: BACKGROUND
  Despite the positive impact of Palliative Care (PC) on the quality of life for patients and their relatives, the implementation of PC in non-cancer health-care delivery in the EU seems scarcely addressed. The aim of this study is to assess guidelines/pathways for integrated PC in patients with advanced Chronic Heart Failure (CHF) and Chronic Obstructive Pulmonary Disease (COPD) in Europe via a systematic literature review.
  
  
  METHODS
  Search results were screened by two reviewers. Eligible studies of adult patients with CHF or COPD published between 01/01/1995 and 31/12/2013 in Europe in 6 languages were included. Nine electronic databases were searched, 6 journals were hand-searched and citation tracking was also performed. For the analysis, a narrative synthesis was employed.
  
  
  RESULTS
  The search strategy revealed 26,256 studies without duplicates. From these, 19 studies were included in the review; 17 guidelines and 2 pathways. 18 out of 19 focused on suffering reduction interventions, 13/19 on a holistic approach and 15/19 on discussions of illness prognosis and limitations. The involvement of a PC team was mentioned in 13/19 studies, the assessment of the patients' goals of care in 12/19 and the advance care planning in 11/19. Only 4/19 studies elaborated on aspects such as grief and bereavement care, 7/19 on treatment in the last hours of life and 8/19 on the continuation of goal adjustment.
  
  
  CONCLUSIONS
  The results illustrate that there is a growing awareness for the importance of integrated PC in patients with advanced CHF or COPD. At the same time, however, they signal the need for the development of standardized strategies so that existing barriers are alleviated.
authors.affiliation: Department of Radiation-Oncology and Palliative Medicine, University Hospital Gasthuisberg, Leuven, Belgium. naouma.siouta@gmail.com.
authors.forename: Naouma
authors.initials: N
authors.lastname: Siouta
authors.affiliation: Department of Radiation-Oncology and Palliative Medicine, University Hospital Gasthuisberg, Leuven, Belgium.
authors.forename: Karen
authors.initials: K
authors.lastname: van Beek
authors.affiliation: International Observatory on End of Life Care, Division of Health Research Lancaster University, Lancaster, United Kingdom.
authors.forename: Nancy
authors.initials: N
authors.lastname: Preston
authors.affiliation: Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Jeroen
authors.initials: J
authors.lastname: Hasselaar
authors.affiliation: International Observatory on End of Life Care, Division of Health Research Lancaster University, Lancaster, United Kingdom.
authors.forename: Sean
authors.initials: S
authors.lastname: Hughes
authors.affiliation: International Observatory on End of Life Care, Division of Health Research Lancaster University, Lancaster, United Kingdom.
authors.forename: Sheila
authors.initials: S
authors.lastname: Payne
authors.affiliation: Department of Palliative Medicine, University of Navarra Hospital, Pamplona, Navarra, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Garralda
authors.affiliation: Department of Palliative Medicine, University of Navarra Hospital, Pamplona, Navarra, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Centeno
authors.affiliation: Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Marlieke
authors.initials: M
authors.lastname: van der Eerden
authors.affiliation: Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Marieke
authors.initials: M
authors.lastname: Groot
authors.affiliation: Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany.
authors.forename: Farina
authors.initials: F
authors.lastname: Hodiamont
authors.affiliation: Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany.
authors.forename: Lukas
authors.initials: L
authors.lastname: Radbruch
authors.affiliation: Faculty of Medicine, Institute of Family Medicine, University of Pécs Medical School, Pécs, Hungary.
authors.forename: Csilla
authors.initials: C
authors.lastname: Busa
authors.affiliation: Faculty of Medicine, Institute of Family Medicine, University of Pécs Medical School, Pécs, Hungary.
authors.forename: Agnes
authors.initials: A
authors.lastname: Csikos
authors.affiliation: Department of Radiation-Oncology and Palliative Medicine, University Hospital Gasthuisberg, Leuven, Belgium.
authors.forename: Johan
authors.initials: J
authors.lastname: Menten
mesh_terms: D032722:Advance Care Planning / Q000706:statistics & numerical data*; D002908:Chronic Disease / Q000628:therapy; D005060:Europe; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D010166:Palliative Care / Q000379:methods / Q000706:statistics & numerical data*; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D011788:Quality of Life