• Patricia M Davidson, Glenn Paull, Kate Introna, Jill Cockburn, Jan Maree Davis, David Rees, David Gorman, Linda Magann, Mary Lafferty, and Kathleen Dracup.
• School of Nursing, Family and Community Health, University of Western Sydney, & Western Sydney Area Health Service, Sydney, Australia. patricia_davidson@wsahs.nsw.gov.au
• J Cardiovasc Nurs. 2004 Jan 1;19(1):68-75.

BackgroundChronic heart failure (HF) is the only heart condition increasing in prevalence and is primarily a condition of aging. This condition has outcomes worse than many cancers; however, patients are often denied the benefits of palliative care with its important emphasis on symptom management, spirituality, and emotional health and focus on family issues.AimTo describe the development of a model of an integrated, consultative, palliative care approach within a comprehensive HF community-focussed disease management program.MethodA collaborative model was developed following a systematic needs assessment and documentation of local resources. Principles underpinning this model were based upon fostering of communication, consultancy, and skill development. Within this model a health care system, based upon universal coverage, supported co-management of patients and their families. The place of death, level of social support available at home, and degree of palliative care involvement was documented in 121 consecutive deaths from 1999-2002.FindingsFollowing a period of skill sharing and program development, only 8.3% of HF patients in the collaborative program required specialized palliative care intervention for complex symptom management, carer support, and issues related to spirituality. Twenty percent of this cohort died in nursing homes underscoring the importance of supporting our nursing colleagues in this setting.ConclusionsIn spite of well-documented difficulties in determining prognosis, it is the St George experience that key principles of a palliative care strategy can be implemented in a HF disease management program with support and consultancy from expert palliative care services.

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