Abstract
Although palliative care has been shown to be an effective way to manage distressing symptoms in end-stage heart failure, patients are infrequently referred to palliative home care following hospital discharge for an exacerbation. The purpose of this 2-phase mixed-methods study was to examine factors that influence the transition of patients with end-stage heart failure to palliative home care. A 45-item online survey was randomly distributed to 92 home care agencies across New York State. Two-thirds of the home care agencies offered palliative care, whereas one-third had only hospice. Although the majority of nurses (87.7%) reported ability to refer patients to palliative care, nurse managers were identified as the main source for referrals. Nurse demographics were not correlated with a greater number of palliative care referrals, whereas experience with palliative care was. Diagnosis was associated with a greater number of palliative care referrals than presence of pain or declining functional status. Improvements in discharge planning protocols that can evaluate patients who could benefit from palliative care prior to home care admission are needed. Home-based palliative care could improve quality of life by managing symptoms and exacerbations, which could reduce hospital readmissions.