Systematic Methods to Assess End-of-Life and Palliative Care Needs for Heart Failure Home Care

IntroductionAdvanced heart failure (HF) often requires comprehensive home-based management, including attention to palliative care needs. Early identification of these needs can improve symptom control, safety, and quality of life for patients and families.PurposeThe purpose is to examine end-of-life (EOL) and palliative care needs in the context of home-based HF management using systematic nursing observations and valid assessment questionnaires.MethodsThis descriptive, observational study assessed home palliative care needs among 18 patients with HF and their family caregivers enrolled in a rural Appalachian clinical trial. Data sources included questionnaires and nurses' observation notes. Home palliative care needs were assessed using: (1) the Integrated Palliative Care Outcome Scale (IPOS) to capture symptom burden; (2) EOL goals and preferences to identify care priorities; (3) a home safety checklist to evaluate environmental risks; and (4) nurse observation notes to document home visits and care challenges.ResultsPatients with HF exhibited high symptom burden and home safety gaps. IPOS scores indicated persistent physical and psychosocial symptoms, with partial patient, caregiver concordance on EOL priorities but notable deficits in advance care planning. Nurse observations revealed additional HF care challenges, including medication adherence and emotional distress. Combining standardized assessments with nurse observations provided a comprehensive view of home-based palliative care needs.ConclusionIntegrating patient and caregiver perspectives with nurse-led assessments enables proactive, home-based interventions that improve safety, symptom control, and shared decision-making. These strategies are essential for delivering patient-centered palliative care for individuals with advanced HF.