Thousands of dying patients, with conditions such as heart failure, are missing out on quality end-of-life care, according to a report.
People with cardiovascular disease were less likely than people with cancer to experience ‘outstanding’ or ‘excellent’ quality of care in the last three months of life, according to the report published by the Personal Social Services Research Unit (PSSRU) at the London School of Economics and Political Science.
Most palliative care goes to cancer patients, even though the diseases account for less than a third of deaths.
Only a fifth of new referrals to specialist end-of-life services are for the two-thirds of people with non-cancer diagnoses.
According to the report, a survey of 233 adult specialist palliative care services in England found that one in ten of the services did not accept people dying of heart failure at all.
It also found that those who had died from cardiovascular disease were less likely to have had their pain fully controlled at home.
Discussing end-of-life care
The report highlighted the failure of clinicians in the UK to talk to people with heart failure who are approaching the end of life about their preferences for care. The report also highlighted that this is a problem not just in the UK but also internationally. A US study that found that less than half of cardiologists discuss palliative care with late-stage heart failure patients, despite professional guidelines suggesting they do so.
We believe that clinicians should discuss end of life with people with end stage heart failure so they can be given choice on where they want to die and the types of care and support they would like to receive. If clinicians continue failing to enter into these discussions, people with heart failure will continue receiving poorer care at the end of life than people with other conditions.
Mike Hobday, our Director of Policy, said: “This report reinforces the evidence that heart patients are missing out on quality palliative care.
“One of the reasons for this is that people with heart failure typically have a less clear prognosis than people with cancer. Our Caring Together programme in Scotland, however, has shown that it is possible to identify patients with heart failure who are entering the end of life phase of their illness.
“We must use the learnings from Caring Together to ensure that heart patients are identified as being at the end of life and they can be given a choice about their end-of-life care.
“We want to see better training for clinicians to give them the confidence to identify patients with heart failure at the end of life and open up conversations with heart patients about their end-of-life-care.
“This will help ensure that patients with heart failure receive access to the same quality care as other terminally ill patients.”