Barriers and facilitators to a ‘good death’ in heart failure: An integrative review

Background: Heart failure is the final common pathway of many cardiovascular diseases, and yet many individuals with heart failure die hospitalised, suffering needlessly and experiencing what could be termed a ‘bad death’. While it is essential to address the wishes of individuals and their families in improving the quality of end-of-life care for patients with heart failure, their unmet needs remain poorly understood. Aim: To systematically review the literature describing a good death or end-of-life care in heart failure and to synthesise identified studies to describe how elements of heart failure care may contribute to a good death. Methods: PubMed and Scopus were searched from January 2001 to April 2018. The method of Whittemore and Knafl guided this review to identify emergent themes. Findings: Of the 436 studies identified, 43 met the inclusion criteria. Five themes associated with end-of-life care in heart failure and a good death were generated: (1) location of death, (2) preferred care, (3) palliative care utilisation, (4) interventions to improve the likelihood of a good death, (5) the intersection of individual, family, healthcare providers, and community-level factors. Discussion: This integrative review highlights a number of factors that prevent patients with heart failure from receiving palliative care, such as difficulty predicting mortality, late referral misconception of the role of palliative care and low availability of resources. Conclusion: This review has identified modifiable barriers and facilitator of a good death and emphasised the importance of considering the intersection of patient, provider and healthcare system issues in facilitating a good death for patients with heart failure.