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BACKGROUND/PURPOSE
End-stage cardiac disease processes lead to progressive, symptomatic and complex end-of-life
care. Associated with physical and emotional distress, advanced cardiac disease remains
undertreated in the outpatient population that presents a unique symptom burden, increased
caregiver demands, and variable disease trajectory, all leading to challenging prognostication.
The palliative approach to care of cardiac life-limiting disease helps improve the
quality of life for patients and their caregivers. Historically, the focus of palliative
care has been malignant disease processes with clear transition points, rather than
diseases with non-linear trajectories. Due to its varying clinical course and life-limiting
progression, cardiac disease prognostication is difficult, thus challenging the norms
of approaches to palliative care. Cardiologists, cardiac patients and their caregivers
are confronted with the management of end-stage cardiac disease while respecting the
wishes of patient and caregiver for quality palliative and end-of-life care.
METHODS/RESULTS
The University of Ottawa Heart Institute's (UOHI) innovative Cardiac Supportive and
Palliative Care Program (CSPCP) provides specialized outpatient service for patients
diagnosed with advanced cardiac disease. The program's goal is to initiate and bridge
access to cardiac palliative care across Eastern Ontario. End-stage cardiac disease
patients are referred for symptom management, goals of care discussion, advance care
planning, community care coordination, caregiver support and end-of-life planning.
In collaboration with UOHI allied health services and community resources, and under
the direction of a Cardiologist with expertise in palliative care, the Advanced Practice
Nurse (APN) is able to fulfill a supportive and consultative role. Advanced medical
assessments, in-depth cardiac symptom management, and community care coordination
support, respect, and honour the patient's goals of care. Using direct clinical and
comprehensive care, the APN optimizes and synthesizes health information, provides
patient and caregiver education, and ensures optimal end-stage cardiac palliative
patient care. With this innovative model of care, the UOHI CSPCP has successfully
met the needs of end-stage cardiac patients and their caregivers throughout Eastern
Ontario.
CONCLUSION/IMPLICATIONS FOR PRACTICE
Through a complex case study, one is best able to understand the APN's role in facilitating
excellent cardiac palliative care. Implementing CSPCP has allowed patients to explore
their goals of care and advance care plans with the UOHI CSPCP team, optimize end-stage
cardiac symptom burden, initiate home care services and provide quality end-of-life
care.
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© 2021 Published by Elsevier Inc.
