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Introduction: Congestive Heart Failure (CHF) is an increasingly prevalent terminal illness in a globally aging population.
Despite optimal medical management, prognosis remains poor – a fact seldom communicated to patients and/or their families.
Evidence suggests numerous benefits of palliative care consultation in advanced CHF but to date, their services remain woefully
Objectives: To identify specific challenges to accessing and implementing palliative care in patients with advanced CHF and
to use this information to formulate recommendations for practice.
Methods: Literature review whereby recommendations for practice were formulated on the basis of primary quantitative/
qualitative data and consensus expert opinion.
Results: Accessing palliative care services for patients with CHF remains a challenge for numerous factors including prognostic
uncertainty, misconceptions about what palliative care is, and difficulty recognizing when a patient is suitable for referral.
Strategies to improve access/delivery of palliative care to this population include education and proper discussion about
prognosis/goals of care. A team-based approach is essential as we move towards a model where symptom palliation exists
concurrently with active medical disease-modifying treatment.
Conclusion: Despite evidence that palliative care has a role in improving symptom control and overall quality of life in patients
with end-stage CHF, a multitude of challenges exist and this ultimately hinders access to palliative care services. Education to
abolish pre-existing misconceptions about the role of palliative care and a movement towards a team-based approach focused
on simultaneous palliative and traditional medical care will undoubtedly improve access to and benefit from palliative care
services in this population.
Senderovich is a physician at Baycrest Health Science System. Her practice is focused on Palliative Care, Pain Medicine and Geriatrics. She is an Assistant Professor at the Department of Family and Community Medicine, and Division of Palliative Care at the University of Toronto who is actively involved teaching medical students and residents. She has broad international experience and a solid research background. Her research was accepted nationally and internationally. She is an author of multiple manuscripts focused on geriatrics, patient - centered care, ethical and legal aspect of doctor-patient relationship, palliative and end-of-life care.