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Hindi Research Article
Self-assessment and Screening for Palliative Care Need in Patients with Chronic Heart Failure
Karin Oechsle1*, Jennifer Ehlert1, Yskert von Kodolitsch2, Anneke Ullrich1, Carsten Bokemeyer1 and Meike Rybczynski21Department of Oncology, Hematology and Bone Marrow Transplantation, Palliative Care Unit, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
2Department of Cardiology, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
- Corresponding Author:
- Karin Oechsle
Department of Oncology, Hematology and BMT
University Medical Center Hamburg-Eppendorf
Martinistr. 52, 20246 Hamburg, Germany
Tel: 49/40/7410-58774
Fax: 49/40/7410-58841
E-mail: k.oechsle@uke.de
Received Date: April 08, 2017; Accepted Date: April 29, 2017; Published Date: May 04, 2017
Citation: Oechsle1 K, Ehlert J, Kodolitsch Y, Ullrich A, Bokemeyer C, et al. (2017) Self-assessment and Screening for Palliative Care Need in Patients with Chronic Heart Failure. J Palliat Care Med 7:304. doi:10.4172/2165-7386.1000304
Copyright: © 2017 Oechsle K, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
Objective: Patients with chronic heart failure (CHF) rarely receive palliative care today.
Methods: In a cross-sectional pilot study we evaluated feasibility of self-assessment and physician-directed screening for palliative care need in CHF patients. Patients answered German versions of the “Minimal Documentation system for patients in palliative care” (MIDOS), “Distress-Thermometer” (DT), and the “Patient Health Questionnaire” (PHQ4). A modified version of the “Five-Item Palliative Care Screening Tool” was used to screen for palliative care need by the treating cardiologists.
Results: 218 patients were asked to participate and 148 (67%) completed all questionnaires. Median symptom burden (MIDOS) was 7 out of 30 points (SD 4.868), overall wellbeing was two of 5 (SD 0.902), and median distress score was 6 of 10 (SD 2.318). Most frequent moderate or severe symptoms were dyspnea (52%), weakness (51%), and tiredness (49%). Significant distress (DT score>5) was indicated by 106 patients (72%). Exhaustion (79%), sleeping problems (75%), and problems with breathing (69%) were most frequent problems. Only 11% and 14% of patients presented with significant anxiety and depression, respectively (PHQ4-score>3).
Palliative care need was scored with mean 6.8 out of 12 points (SD 2.223). Using a cut-off value of >5, 113 patients (76%) would have needed palliative care. Objective parameters for palliative care need (symptom burden 43%, distress 68%, decision-making 67%) were indicated, but request for palliative care by the patients, their relatives (5%) or the cardiology team (5%) was rare. Symptom burden and palliative care screening showed significant, but not clinically relevant interaction.
Conclusion: This pilot study, feasibility of palliative care self-assessment and the modified screening instrument could be demonstrated in CHF patients. For comprehensive screening, both perspectives have to be included. First results indicate significant symptom burden, psychological distress and a high need for additional palliative care in CHF patients.
