title: An Intervention to Enhance Goals-of-Care Communication Between Heart Failure Patients and Heart Failure Providers.
abstract: Heart failure patients contend with a markedly impaired quality of life, experiencing emotional distress and severe physical discomfort that increases in frequency in the last months of life. Improving communication between patients and providers about goals of care has the potential to improve patient-provider communication and patient outcomes.
  
  
  
  To determine the effects of a goals-of-care (GoC) intervention compared to usual care on the number of GoC conversations, quality of communication between patients and providers, referrals to palliative care services and completion of advance care directives.
  
  
  
  A two-group randomized study (n = 40/group) compared a GoC intervention to usual care, conducted in an academic heart failure (HF) clinic. The GoC intervention was a previsit patient activation-education, telephone-based intervention delivered by a nurse. The primary outcome of the study was number of GoC conversations between HF patients and HF providers. Secondary outcomes were quality of communication, number of referrals to palliative care, and completion of advance directives.
  
  
  
  Patients averaged 58.15 ± 11.26 years of age, with mean left ventricular ejection fraction = 30.31 ± 9.72% and Seattle Heart Failure Model scores = 95.1 ± 1.60. There was a significant increase in goals-of-care conversations (58% vs. 2.6%, P < 0.001) and quality of end-of-life communication (P = 0.03) in the GoC group compared to usual care after the intervention. There were no differences between groups on the other outcomes.
  
  
  
  The GoC intervention resulted in more GoC conversations and higher quality communication between HF patients and providers without increased anxiety or depression. Further studies are needed to assess impact on longer term quality of care and patient outcomes.
authors.affiliation: School of Nursing, University of Washington, Seattle, Washington, USA; School of Medicine, University of Washington, Seattle, Washington, USA. Electronic address: doorenbo@uw.edu.
authors.forename: Ardith Z
authors.initials: AZ
authors.lastname: Doorenbos
authors.affiliation: School of Medicine, University of Washington, Seattle, Washington, USA.
authors.forename: Wayne C
authors.initials: WC
authors.lastname: Levy
authors.affiliation: School of Medicine, University of Washington, Seattle, Washington, USA.
authors.forename: J Randall
authors.initials: JR
authors.lastname: Curtis
authors.affiliation: School of Nursing, University of Washington, Seattle, Washington, USA; School of Medicine, University of Washington, Seattle, Washington, USA.
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Dougherty
mesh_terms: D016223:Advance Directives; D003142:Communication; D005260:Female; D006333:Heart Failure / Q000523:psychology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009726:Nurses; D010166:Palliative Care; D010347:Patient Care Planning; D010353:Patient Education as Topic; D011369:Professional-Patient Relations; D011787:Quality of Health Care; D012017:Referral and Consultation; D017216:Telemedicine; D013727:Terminal Care; D016896:Treatment Outcome
keywords: Goals of care; communication; end of life; heart failure; palliative care