Communication in end-of-life cardiac care 1: difficult issues.

NICE (2003) guidance on chronic heart failure stated: ‘Issues of sudden death and living with uncertainty are pertinent to all patients with heart failure. The opportunity to discuss these issues should be available at all stages of care.’

The National Service Framework for Coronary Heart Disease (Department of Health, 2000a) recommended a palliative approach in managing end-stage heart failure. It also advised: ‘Open communication about disease outcomes should be offered to all patients suffering from heart failure,’ (see box).

Despite these recommendations, the literature reports that clinical staff very rarely discuss with patients the likelihood of them dying. In most cases patients come to this conclusion themselves, with only the minority formally told (Gibbs et al, 2002; McCarthy et al, 1997). From the literature it is evident that cardiologists are comfortable discussing treatment options but less confident in asking patients open questions about terminal care. Wotton et al (2005) identified that open communication is rare among patients undergoing cardiac care and health professionals, leading to suboptimal palliative care and a failure to identify and honour patients’ wishes. Having access to clinical staff with the skills to address these issues is clearly important.