Lessons from the Literature

2020; Volume 21, No 11, November

Under My Microscope

Dr. Tania Pastrana. Used with permission.

IAHPC Research Advisor Dr. Tania Pastrana selects one article from recently published medical literature and describes why it is worthwhile.

Integration of a Palliative Approach into Heart Failure Care: a European Society of Cardiology Heart Failure Association position paper

Hill L, Prager Geller T, Baruah R, Beattie JM, Boyne J, at al. Eur J Heart Fail. Available online September 6, 2020. DOI: 10.1002/ejhf.1994

Both adults and children with advanced heart failure experience a high symptom burden. In addition to dyspnea and fatigue as a result of their disease, patients also have a high burden of somatic complaints, such as pain, nausea, anxiety, and depression, leading to significant psychosocial distress for both patients and their caregivers, producing serious health-related suffering.1 However, despite the evidence supporting the integration of palliative care into the overall care of patients with these conditions, the integration of palliative care in heart failure care is still limited. Possible barriers to integrating palliative care may be prognostication difficulties as well as caregiver inexperience with end-of-life issues specific to advanced heart failure.2

In this paper, the authors “aim to provide day-to-day practical clinical guidance on these topics, supporting the coordinated provision of palliation strategies as goals of care fluctuate along the heart failure disease trajectory.“


1. Knaul FM, Farmer PE, Kralauer EL, De Lima L, Bhadelia A, et al. Alleviating the Access Abyss in Palliative Care and Pain Relief — An imperative of universal health coverage: the Lancet Commission report. Lancet 2017; 391(10128): 1391-1454.

2. LeMond L, Allen LA. Palliative care and hospice in advanced heart failure. Progress in Cardiovascular Diseases. Prog Cardiovasc Dis 2018; 54(2): 168-178.

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The Heart Failure Association of the European Society of Cardiology has published a previous position paper and various guidelines over the past decade recognizing the value of palliative care for those affected by this burdensome condition. Integrating palliative care into evidence?based heart failure management remains challenging for many professionals, as it includes the identification of palliative care needs, symptom control, adjustment of drug and device therapy, advance care planning, family and informal caregiver support, and trying to ensure a ‘good death’. This new position paper aims to provide day?to?day practical clinical guidance on these topics, supporting the coordinated provision of palliation strategies as goals of care fluctuate along the heart failure disease trajectory. The specific components of palliative care for symptom alleviation, spiritual and psychosocial support, and the appropriate modification of guideline?directed treatment protocols, including drug deprescription and device deactivation, are described for the chronic, crisis and terminal phases of heart failure.

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Media Watch: Last Aid, care during crisis, public policy survey

The articles below are selected from Barry R. Ashpole’s weekly report, Media Watch.

Why Should Everybody Learn Last Aid to Provide End-of-Life Care?

Archives of Community Medicine & Public Health, 2020; 6(2): 198-199. Last Aid (LA) courses have been created to inform the public about palliative care (PC) and to encourage an open public discussion about death and dying. They inform people about what they can do to relieve suffering and provide information where citizens can get help from professionals. At present sixteen countries participate in the International LA working group. More than 26,000 citizens have been taught LA and more than 2,000 LA course instructors have been educated. DOI: 10.17352/2455-5479.000105

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Systems of Care in Crisis: The changing nature of palliative care during COVID-19

Journal of Bioethical Inquiry | Online – 25 August 2020 – Among the far-reaching impacts of COVID-19 is its impact on the systems that we rely on to maintain and provide care for those with “illness.” The authors explore the influence on palliative care (PC) systems that have arisen during the COVID-19 pandemic. They explore the impact on the meaning of care, how care is performed and identified, and the responses of PC systems to these challenges. The authors highlight the current and potential future implications of these dynamics within the unfolding crisis of this pandemic. DOI: 10.1007/s11673-020-10006-x

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Palliative Care in Public Policy: Results from a global survey

Palliative Medicine Reports | Online – 15 September 2020 – National policy recognition for palliative care (PC) is far from universal and is generally confined to high-income countries. There is evidence, however, that a significant number of others, including low- and middle-income countries, are making progress in this direction. A 2015 World Health Organization (WHO) survey reported that 37% of countries had an operational national policy for noncommunicable diseases that included PC. This is a higher figure than the authors report for the number of countries with a stand-alone policy. DOI: 10.1089/pmr.2020.0062

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Also of interest:

A mixed-method evaluation of a volunteer navigation intervention for older persons living with chronic illness (Nav-CARE): Findings from a knowledge translation study. Full text

Palliative care delivery in residential aged care: Bereaved family member experiences of the Supportive Hospice Aged Residential Exchange (SHARE) intervention. Full text

Media Watch, published by Barry R. Ashpole, a Canadian communications consultant and educator, monitors the literature and the lay press on issues specific to the quality of end-of-life care. It is international in scope and distribution. View current and back issues here.

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