Evidence map›Paper›PMID 39098653›Full record

ArticleJournal of cardiac failure2025

Clinician Insights into Effective Components, Delivery Characteristics and Implementation Strategies of Ambulatory Palliative Care for People with Heart Failure: A Qualitative Analysis.

Shelli Feder, Lynne Iannone, Dora Lendvai, Yan Zhan, Kathleen Akgün, Mary Ersek, Carol Luhrs, Larry A Allen, David B Bekelman, Nathan Goldstein and 1 more

Abstract readMulticenter Study
In one paragraph

Article in Journal of cardiac failure, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. The role of temporary mechanical circulatory support in heart failure.European heart journal supplements : journal of the European Society of Cardiology · 2025
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Shelli FederYale School of Nursing, New Haven, CT; VA Connecticut Healthcare System, West Haven, CT. Electronic address: shelli.feder@yale.edu.
Lynne IannoneVA Connecticut Healthcare System, West Haven, CT; Yale School of Medicine, New Haven, CT.
Dora LendvaiYale School of Nursing, New Haven, CT; VA Connecticut Healthcare System, West Haven, CT.
Yan ZhanYale School of Nursing, New Haven, CT.
Kathleen AkgünVA Connecticut Healthcare System, West Haven, CT; Yale School of Medicine, New Haven, CT.
Mary ErsekMichael C. Cresenz VA Medical Center, Leonard Davis Institute, University of Pennsylvania, Philadelphia, PA.
Carol LuhrsVA New York Harbor Healthcare System, New York, NY.
Larry A AllenDivision of Cardiology, University of Colorado School of Medicine, Boulder, CO.
David B BekelmanDepartment of Medicine, VA Eastern Colorado Health Care System and Division of General Internal Medicine and the University of Colorado Anschutz Medical Campus, Aurora, CO.
Nathan GoldsteinDepartment of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH.
Dio KavalieratosDivision of Palliative Medicine, Emory University, Atlanta, GA.

Funding

Yale Clinical and Translational Science Award (U Component)UL1TR001863 · NCATS · YALE UNIVERSITY · PI John H. Krystal, LUCILA OHNO-MACHADO · 2016 to 2026
$102.9M
Yale Study Support Suite (YES3): Dashboard and Web Portal Software Supporting Research Workflow through integrated, customizable REDCap External ModulesP30AG021342 · NIA · YALE UNIVERSITY · PI Albert C Shaw · 2002 to 2026
$37.9M
Palliative Care Research Cooperative Group (PCRC): Refinement and ExpansionU2CNR014637 · NINR · UNIVERSITY OF COLORADO DENVER · PI HANSON, LAURA C · 2018 to 2022
$8.6M
Identifying Successful Strategies of Specialist Palliative Care Implementation for People with Advanced Heart FailureR01HL172840 · NHLBI · YALE UNIVERSITY · PI Shelli Leore Feder · 2024 to 2026
$2.0M
Mid-Career Mentoring Award in Palliative Care, Aging, and Cognitive ImpairmentK24AG070322 · NIA · UNIVERSITY OF COLORADO DENVER · PI David B. Bekelman · 2022 to 2026
$930k
Evaluating the Implementation of Specialist Palliative Care for Patients with Advanced Heart FailureR56HL166523 · NHLBI · YALE UNIVERSITY · PI FEDER, SHELLI LEORE · 2023 to 2023
$571k
NCATS NIH HHS UL1 TR001863NHLBI NIH HHS L30 HL159709NHLBI NIH HHS R01 HL172840NHLBI NIH HHS R56 HL166523NIA NIH HHS K24 AG070322NIA NIH HHS P30 AG021342NINR NIH HHS U2C NR014637
6 · The paper itself

Abstract

objectivesTo elicit perspectives from specialist palliative care (SPC) and cardiology clinicians concerning the necessary components, delivery characteristics and implementation strategies of successful ambulatory SPC for people with heart failure (HF).

backgroundPalliative care is a recommended component of guideline-directed care for people with HF. However, optimal strategies to implement SPC within ambulatory settings are unknown.

methodsWe conducted a qualitative descriptive study composed of semistructured interviews with SPC and cardiology clinicians at Veterans Affairs Medical Centers (VAMCs) with the highest number of ambulatory SPC consultations within the VA system among people with HF between 2021 and 2022. Clinicians were asked how they provided ambulatory SPC and what they felt were the necessary components, delivery characteristics and implementation strategies of care delivery. Interviews were analyzed using directed content analysis.

resultsWe interviewed 14 SPC clinicians and 9 cardiology clinicians at 7 national VAMCs; 43% were physicians, and 48% were advanced-practice registered nurses/physician associates. Essential components of ambulatory SPC encompassed discussion of goals of care (eg, prognosis, advance directives) and connecting patients/caregivers to resources (eg, home care). Preferred delivery characteristics included integrated (ie, embedded) approaches to SPC delivery, standardized patient selection and referral procedures, and formalized procedures for handoffs to and from SPC. Strategies that addressed SPC implementation included deploying palliative champions, educating non-SPC clinicians on the value of ambulatory SPC for people with HF and developing ambulatory models through leadership support. CONCLUSIONS/IMPLICATIONS: Facilitating the broader adoption of ambulatory SPC among people with HF may be achieved by prioritizing these mutually valued and necessary features of SPC delivery.

Indexed as

Ambulatory CareHeart FailurePalliative CareFemaleHumansMaleMiddle AgedQualitative ResearchUnited States

Identifiers

PMID39098653
PMCPMC11787406

What OpenQuestion holds

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Registered trials

None linked

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.