BMJ 2002;325:581-585 ( 14 September )

Primary care

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

Barbara Hanratty, clinical lecturer, ^a Derek Hibbert, research associate, ^b Frances Mair, senior lecturer in general practice, ^b Carl May, professor of medical sociology, ^c Christopher Ward, consultant, ^d Simon Capewell, professor of clinical epidemiology, ^a Andrea Litva, lecturer in medical sociology, ^b Ged Corcoran, consultant. ^e

^a Department of Public Health, University of Liverpool, Liverpool L69 3GB, ^b Department of Primary Care, University of Liverpool, ^c Centre for Health Services Research, University of Newcastle upon Tyne, Newcastle upon Tyne NE3 1SX, ^d Department of Cardiology, Wythenshawe Hospital, Manchester M23 9LT, ^e Department of Palliative Care, University Hospital Aintree, Liverpool L9 7AL

Correspondence to: B Hanratty B.Hanratty{at}liverpool.ac.uk

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.

What is already known on this topic Patients with heart failure have unmet needs for health care at the end of life Specialist palliative care services see few patients with heart failure The national service framework for coronary heart disease endorses the provision of palliative care for heart failure Little evidence exists on how this care should be provided, and doctors' views are not known What this study adds Barriers to adopting a palliative care approach in heart failure care relate to the current organisation of health services, the difficulties of prognostication, and doctors' understanding of roles and responsibilities Doctors believe that the general practitioner should be the central figure in palliative care for heart failure, supported by specialists Doctors' future priorities are developing the role of nurses, increasing essential community services, such as district nursing, and improving communication with colleagues

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