Integrating Palliative Care into Oncology Management: Lessons from Heart Failure

By Carolyn Blair and Tracey McConnell

Integration of palliative care is the linchpin to effective management of chronic complex conditions such as heart failure and cancer. While more attention has been paid to integrating palliative care into oncology, efforts in heart failure management have faced multiple challenges. This blog is based on a recent realist review which explored the integration of palliative care into heart failure management (https://palliatheartsynthesis.co.uk/), shedding light on strategies for successful integration which may also be relevant to oncology.

The study aimed to develop a comprehensive understanding of why, for whom, and in what contexts integrated palliative care and heart failure services work or do not work. It also sought to utilise this understanding to co-produce intervention strategies for integration of both services with stakeholders, informing best practices and future research. Employing a systematic approach, the study analysed published articles and grey literature using a realist logic of analysis. Data from November 2021 to April 2023 were gathered from various databases and stakeholder inputs, including patients, carers, content experts, and practitioners. The review encompassed 130 documents, comprising research papers, literature reviews, and grey literature. 

Through the analysis, the study identified intervention strategies to support the integration of palliative care and heart failure services. These strategies included dedicated time for evidence-based education at undergraduate and postgraduate levels, increased awareness of palliative care benefits for heart failure, and the importance of credible champions advocating for integration. The findings underscore the crucial steps required to facilitate the integration of palliative care into heart failure management. By ensuring that service providers possess the necessary motivation, opportunities, and capabilities, the likelihood of successful integration can be enhanced.

Despite the focus on heart failure in this study, the implications also extend to oncology and pioneer the need for Integrated Palliative Care in Oncology (IPCO). Just as in heart failure, integrating palliative care into oncology requires concerted efforts and tailored strategies which the current realist synthesis on this topic will uncover. Similarly, healthcare providers must be equipped with the motivation and resources to integrate palliative care into cancer care, and the findings from IPCO will provide valuable insights into how this may be possible.

As healthcare continues to evolve, integration remains paramount for optimal patient outcomes, particularly in conditions like heart failure and cancer. By drawing insights from studies like the one discussed here, we can pave the way for more effective integration of palliative care into oncology management, ensuring holistic care for patients facing life-limiting illnesses. The study’s findings offer actionable insights for healthcare practitioners, policymakers, and researchers alike. By prioritising integration efforts and fostering a collaborative approach, we can bridge the gap between palliative care and disease management, ultimately enhancing the quality of life for patients across various medical contexts.

To read more about this study please see –  McConnell T, Blair C, Burden J, et al. Integrating palliative care and heart failure: a systematic realist synthesis (PalliatHeartSynthesis). Open Heart 2023;10:e002438. doi:10.1136/ openhrt-2023-002438

Correspondence to Dr Tracey McConnell; t. mcconnell@qub.ac.uk

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