ArticleJournal of the American Heart Association2014
"Not the 'grim reaper service'": an assessment of provider knowledge, attitudes, and perceptions regarding palliative care referral barriers in heart failure.
Article in Journal of the American Heart Association, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 122 papers, 7 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
122 citing papers in PubMed, 7 syntheses or guidelines pooled it, 259 citations in OpenAlex.
- Pooled it
- Factors associated with hospitalisations of patients with chronic heart failure approaching the end of life: A systematic review.Palliative medicine · 2022Pooled it
- A Systematic Review of the Development and Implementation of Needs-Based Palliative Care Tools in Heart Failure and Chronic Respiratory Disease.Frontiers in cardiovascular medicine · 2022Pooled it
- Survival of patients with chronic heart failure in the community: a systematic review and meta-analysis.European journal of heart failure · 2019Pooled it
- Pooled it
- Impact of Interdisciplinary Outpatient Specialty Palliative Care on Survival and Quality of Life in Adults With Advanced Cancer: A Meta-Analysis of Randomized Controlled Trials.Annals of behavioral medicine : a publication of the Society of Behavioral Medicine · 2019Pooled it
- Pooled it
- Perceptions of Need for Palliative Care in Recently Hospitalized Patients With Systolic Heart Failure.Journal of pain and symptom management · 2021Trial
- Effects of a transitional palliative care model on patients with end-stage heart failure: a randomised controlled trial.Heart (British Cardiac Society) · 2016Trial
- Primary palliative care for heart failure provided within ambulatory cardiology: A randomized pilot trial.Heart & lung : the journal of critical careTrial
- Patient-centred understanding of quality of life, symptoms, health equity in cystic fibrosis (PULSE-CF): study protocol for an observational study.BMJ open respiratory research · 2026Article
- Reach of Palliative Care in Parkinson Disease: Progress and Gaps After a National Team-Based Implementation Project.Neurology. Clinical practice · 2026Article
- Promoting palliative care for people with heart failure: the P3HF study protocol.BMC palliative care · 2026Article
- Feasibility and acceptability of a rural palliative care intervention for patients with heart failure (RuPAL-HF).BMC palliative care · 2026Article
- Psychological and behavioral mechanisms that drive medical staff's engagement in kidney palliative care-an empirical analysis from medical staff in mainland China.BMC health services research · 2026Article
- Article
- Designing a Clinical Decision Support Tool to Promote Timely Palliative Care in Heart Failure.medRxiv : the preprint server for health sciences · 2026Article
- Unpacking Multi-Layered Challenges in Palliative Care Transitions: A Descriptive Qualitative Study of Multidisciplinary Teams in China.Journal of multidisciplinary healthcare · 2026Article
- Difference-Making Factors Linked to Higher Reach of Specialist Palliative Care Among People With Heart Failure Across a National Sample of VA Medical Centers.The American journal of hospice & palliative care · 2025Article
- Patients' and Caregivers' Perspectives on the Role of Ambulatory Specialty Palliative Care for People With Heart Failure.Journal of pain and symptom management · 2025Article
62 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
8 authors at 4 institutions in 1 country.
Funding
Abstract
backgroundAlthough similar to cancer patients regarding symptom burden and prognosis, patients with heart failure (HF) tend to receive palliative care far less frequently. We sought to explore factors perceived by cardiology, primary care, and palliative care providers to impede palliative care referral for HF patients. METHODS AND
resultsWe conducted semistructured interviews regarding (1) perceived needs of patients with advanced HF; (2) knowledge, attitudes, and experiences with specialist palliative care; (3) perceived indications for and optimal timing of palliative care referral in HF; and (4) perceived barriers to palliative care referral. Two investigators analyzed data using template analysis, a qualitative technique. We interviewed 18 physician, nurse practitioner, and physician assistant providers from 3 specialties: cardiology, primary care, and palliative care. Providers had limited knowledge regarding what palliative care is, and how it can complement traditional HF therapy to decrease HF-related suffering. Interviews identified several potential barriers: the unpredictable course of HF; lack of clear referral triggers across the HF trajectory; and ambiguity regarding what differentiates standard HF therapy from palliative care. Nevertheless, providers expressed interest for integrating palliative care into traditional HF care, but were unsure of how to initiate collaboration.
conclusionsPalliative care referral for HF patients may be suboptimal due to limited provider knowledge and misperceptions of palliative care as a service reserved for those near death. These factors represent potentially modifiable targets for provider education, which may help to improve palliative care referral for HF patients with unresolved disease-related burden.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.