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Primary Care

Doctors' perceptions of palliative care for heart failure: focus group study

BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7364.581 (Published 14 September 2002) Cite this as: BMJ 2002;325:581
  1. Barbara Hanratty, clinical lecturer (B.Hanratty{at}liverpool.ac.uk)a,
  2. Derek Hibbert, research associateb,
  3. Frances Mair, senior lecturer in general practiceb,
  4. Carl May, professor of medical sociologyc,
  5. Christopher Ward, consultantd,
  6. Simon Capewell, professor of clinical epidemiologya,
  7. Andrea Litva, lecturer in medical sociologyb,
  8. Ged Corcoran, consultante
  1. aDepartment of Public Health, University of Liverpool, Liverpool L69 3GB
  2. b Department of Primary Care, University of Liverpool
  3. cCentre for Health Services Research, University of Newcastle upon Tyne, Newcastle upon Tyne NE3 1SX,
  4. dDepartment of Cardiology, Wythenshawe Hospital, Manchester M23 9LT
  5. eDepartment of Palliative Care, University Hospital Aintree, Liverpool L9 7AL
  1. Correspondence to: B Hanratty
  • Accepted 9 July 2002

Abstract

Objectives: To identify doctors' perceptions of the need for palliative care for heart failure and barriers to change.

Design: Qualitative study with focus groups.

Setting: North west England.

Participants: General practitioners and consultants in cardiology, geriatrics, palliative care, and general medicine.

Results: Doctors supported the development of palliative care for patients with heart failure with the general practitioner as a central figure. They were reluctant to endorse expansion of specialist palliative care services. Barriers to developing approaches to palliative care in heart failure related to three main areas: the organisation of health care, the unpredictable course of heart failure, and the doctors' understanding of roles. The health system was thought to work against provision of holistic care, exacerbated by issues of professional rivalry and control. The priorities identified for the future were developing the role of the nurse, better community support for primary care, and enhanced communication between all the health professionals involved in the care of patients with heart failure.

Conclusions: Greater consideration should be given to the care of patients dying with heart failure, clarifying the roles of doctors and nurses in different specialties, and reshaping the services provided for them. Many of the organisational and professional issues are not peculiar to patients dying with heart failure, and addressing such concerns as the lack of coordination and continuity in medical care would benefit all patients.

Footnotes

  • Funding Mersey Primary Care Research and Development Consortium, the Cardiology Research Fund, Department of Cardiology, South Manchester University Hospitals NHS Trust, and the Scientific Foundation Board of the Royal College of General Practitioners

  • Competing interests None declared

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