Integrating values based care conversations in heart failure management for older adults

The focus of this award is to incorporate care practices the emphasize what matters most to older adults managing HF in ways that clinicians can implement. The AHA, ACC, and HFSA recommend geriatric HF management best practices include the integration of patients’ goals, values, and preferences.1, 2 Managing older adults’ HF is particularly challenging due to multimorbidity, polypharmacy, geriatric syndromes, life stage, and changing definition of “quality of life”, all of which can muddle treatment planning, resulting in a neglect of older adults’ values.3, 4 While palliative care specialists—experts in facilitating prognosis and decision-making—are ideal;5, 6 the demand for these clinicians exceeds their availability.7 As a result, the responsibility of these conversations falls to cardiology clinicians.6 To spread this responsibility – and maximize the utility of multidisciplinary teams - cardiology teams often incorporate nurse and social work team members as facilitators.8, 9 Team-based approaches, however, require careful consideration as not all team members may feel empowered to have such conversations8 and some are limited in their scope of practice with respect to clinical questions such as prognosis. Few communication interventions involve interprofessional and multidisciplinary teams, take a system-wide approach, or are designed with patient and clinician input.10 Therefore, my focus of the proposed project is to develop the skills necessary to adapt and evaluate tools to promote values-based communication, using the Serious Illness Care Program (SICP) as a model. Specifically, my training objectives are to 1) Develop advanced skills in data collection, methods, and analysis for implementation research and 2) Gain expertise in designing and conducting a hybrid randomized controlled trial. In lieu of having a decision aid for every possible treatment option, SICP provides an overarching opportunity to elicit patients’ values, goals, and preferences in many chronic illnesses and attends to a range of treatment options to prioritize patient-centered care.