Quality indicators of palliative care for acute cardiovascular diseases. Issue 2 (August 2020)

• Record Type: Journal Article
• Authors: Mizuno, Atsushi; Miyashita, Mitsunori; Kohno, Takashi; Tokuda, Yasuharu; Fujimoto, Shuhei; Nakamura, Masato; Takayama, Morimasa; Niwa, Koichiro; Fukuda, Terunobu; Ishimatsu, Shinichi; Kinoshita, Satomi; Oishi, Shogo; Mochizuki, Hiroki; Utsunomiya, Akemi; Takada, Yasuko; Ochiai, Ryota; Mochizuki, Toshiaki; Nagao, Ken; Yoshida, Saran; Hayashi, Akitoshi; Sekine, Ryuichi; Anzai, Toshihisa
• Is Part Of: Journal of cardiology. Volume 76:Issue 2(2020)
• Page Start: 177
• Page End: 183
• Publication Date: 2020-08
• Subjects: Palliative care -- Acute cardiovascular diseases -- Heart failure -- End-of-life -- Quality indicators; Cardiology -- Periodicals; 616.12
• DOI: 10.1016/j.jjcc.2020.02.010
• Languages: English
• ISSNs: 0914-5087

Abstract

Highlights: A total 21 quality indicators of palliative care were settled. Symptom palliation and supporting decision-making process are two major domains. Outcome measure could only be evaluated by bereaved family survey. Abstract: Background: Although recent attention to palliative care for patients with cardiovascular diseases has been increasing, there are no specific recommendations on detailed palliative care practices. We proceed on a discussion of the appropriateness and applicability of potential quality indicators for acute cardiovascular diseases according to our previous systematic review. Methods: We created a multidisciplinary panel of 20 team members and 7 external validation clinicians composed of clinical cardiologists, a nutritionist, a physiotherapist, a clinical psychologist, a critical and emergent care specialist, a catheterization specialist, a primary care specialist, a palliative care specialist, and nurses. After crafting potential indicators, we performed a Delphi rating, ranging from "1 = minimum" to "9 = maximum". The criterion for the adoption of candidate indicators was set at a total mean score of seven or more. Finally, we subcategorized these indicators into several domains by using exploratory factor analysis. Results: Sixteen of the panel members (80%) were men (age, 49.5 ± 13.7 years old). Among the initial 32 indicators, consensus was initially reached on total 23 indicators (71.8%), which were then summarized into 21 measures by selecting relatively feasible time variations. The major domains were "symptom palliation" and "supporting the decision-making process". Factor analysis could not find optimal model. Narratively-developed seven sub-categories included "presence of palliative care team", "patient-family relationship", "multidisciplinary team approach", "policy of approaching patients", "symptom screening and management", "presence of ethical review board", "collecting and providing information for decision-maker", and "determination of treatment strategy and the sharing of the care team's decision". Conclusion: In this study we developed 21 quality indicators, which were categorized into 2 major domains and 7 sub-categories. These indicators might be useful for many healthcare providers in the initiation and enhancement of palliative care practices for acute cardiovascular diseases in Japan.