Objective: To assess current heart failure (HF) care processes and organizational context in long-term care (LTC) homes as a prelude to adapting the Canadian Cardiovascular Society (CCS) HF guidelines for use in these...Objective: To assess current heart failure (HF) care processes and organizational context in long-term care (LTC) homes as a prelude to adapting the Canadian Cardiovascular Society (CCS) HF guidelines for use in these settings. Methods: This research reports on the results of thirteen focus groups (N = 83 participants;average of 60 minutes duration) conducted in three Ontario LTC homes to better understand how HF was managed and how organizational context impacted care. Participants included physicians, nurse practitioners, registered nurses, registered practical nurses, and personal support workers. Results: Focus group findings revealed that the complexity of the LTC environment presents challenges for managing HF. Most residents have multiple advanced chronic conditions that must be managed simultaneously. Culturally, LTC is first and foremost a resident’s home where residents may choose not to comply with care recommendations. Staff routines, scopes of practice, professional hierarchies, available resources and government regulations limit flexibility in providing care. Staff lacked knowledge, skills and resources for managing HF. Nevertheless, all staff viewed LTC as the preferred place for managing HF, avoiding residents’ hospitalizations wherever possible. These data suggest that strategies for improving LTC staff communication and education, strengthening existing relationships between staff, family, residents and community resources, and acquiring additional resources in LTC homes have the potential to improve HF management in this setting. Conclusion: LTC is a complex and dynamic environment that presents many challenges for providing care for residents. This research provides the foundation for subsequent work to develop and test implementation strategies to manage HF in LTC, which are consistent with the CCS HF guidelines and are feasible within LTC staff’s work routines, capacities and resources.展开更多
Background: The determination of prognosis in heart failure (HF) has focused primarily on the identification of potential biological and physiological markers and not on communication. High morbidity and mortality rat...Background: The determination of prognosis in heart failure (HF) has focused primarily on the identification of potential biological and physiological markers and not on communication. High morbidity and mortality rates suggest that patients require prognostic information to assist in life planning. This study examined the preferences of both patients with HF and cardiologists for prognosis communication in the outpatient clinical setting, with the aim of guiding practitioners in undertaking prognosis conversations. Methods: Using qualitative descriptive techniques informed by a grounded theory approach, 32 patients with HF and 9 cardiologists from outpatient settings in Ontario, Canada were interviewed to identify convergent preferences for prognosis communication. Strategies to enhance methodological rigor were employed. Results: Individualized, context-specific prognosis communication between patients and cardiologists was preferred. Two main themes and ten related attributes were identified to describe convergent preferences;1) Set the Stage for Prognosis Communication, and 2) Map the HF route. Attributes reflected the complex, dynamic, interactive and iterative nature of prognosis communication preferences. Conclusions: Prognosis communication occurs within a complex, adaptive healthcare system. While specific preferences exist, changing contextual elements within and outside of the system create conditions that require cardiologists to adjust their approach to individual patients. Patients with HF and cardiologists each have preferences that affect their willingness and ability to engage in dyadic HF-specific prognosis communication. Findings have relevance for the implementation of any efforts, including HF guidelines, aimed at improving prognosis communication. Our findings, informed by a complexity science approach, offer an innovative and robust alternative to traditional linear approaches to prognosis communication.展开更多
文摘Objective: To assess current heart failure (HF) care processes and organizational context in long-term care (LTC) homes as a prelude to adapting the Canadian Cardiovascular Society (CCS) HF guidelines for use in these settings. Methods: This research reports on the results of thirteen focus groups (N = 83 participants;average of 60 minutes duration) conducted in three Ontario LTC homes to better understand how HF was managed and how organizational context impacted care. Participants included physicians, nurse practitioners, registered nurses, registered practical nurses, and personal support workers. Results: Focus group findings revealed that the complexity of the LTC environment presents challenges for managing HF. Most residents have multiple advanced chronic conditions that must be managed simultaneously. Culturally, LTC is first and foremost a resident’s home where residents may choose not to comply with care recommendations. Staff routines, scopes of practice, professional hierarchies, available resources and government regulations limit flexibility in providing care. Staff lacked knowledge, skills and resources for managing HF. Nevertheless, all staff viewed LTC as the preferred place for managing HF, avoiding residents’ hospitalizations wherever possible. These data suggest that strategies for improving LTC staff communication and education, strengthening existing relationships between staff, family, residents and community resources, and acquiring additional resources in LTC homes have the potential to improve HF management in this setting. Conclusion: LTC is a complex and dynamic environment that presents many challenges for providing care for residents. This research provides the foundation for subsequent work to develop and test implementation strategies to manage HF in LTC, which are consistent with the CCS HF guidelines and are feasible within LTC staff’s work routines, capacities and resources.
文摘Background: The determination of prognosis in heart failure (HF) has focused primarily on the identification of potential biological and physiological markers and not on communication. High morbidity and mortality rates suggest that patients require prognostic information to assist in life planning. This study examined the preferences of both patients with HF and cardiologists for prognosis communication in the outpatient clinical setting, with the aim of guiding practitioners in undertaking prognosis conversations. Methods: Using qualitative descriptive techniques informed by a grounded theory approach, 32 patients with HF and 9 cardiologists from outpatient settings in Ontario, Canada were interviewed to identify convergent preferences for prognosis communication. Strategies to enhance methodological rigor were employed. Results: Individualized, context-specific prognosis communication between patients and cardiologists was preferred. Two main themes and ten related attributes were identified to describe convergent preferences;1) Set the Stage for Prognosis Communication, and 2) Map the HF route. Attributes reflected the complex, dynamic, interactive and iterative nature of prognosis communication preferences. Conclusions: Prognosis communication occurs within a complex, adaptive healthcare system. While specific preferences exist, changing contextual elements within and outside of the system create conditions that require cardiologists to adjust their approach to individual patients. Patients with HF and cardiologists each have preferences that affect their willingness and ability to engage in dyadic HF-specific prognosis communication. Findings have relevance for the implementation of any efforts, including HF guidelines, aimed at improving prognosis communication. Our findings, informed by a complexity science approach, offer an innovative and robust alternative to traditional linear approaches to prognosis communication.
