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editorial
. 2020 Feb 19;2(2):326–329. doi: 10.1016/j.jaccas.2019.11.069

Table 1.

Useful Palliative Care Practices for Cardiologists

Prognostication Formulate an individualized estimate for patients to help them understand their disease status and prognosis while acknowledging the unpredictable nature of the disease; begin such conversations by asking if the patient wants this information to ensure the level of information delivered is in line with their desire for the knowledge.
Communication Engage with patients and their families in shared decision-making by using open-ended question to explore patient understanding, desired outcomes, and how they define optimal outcomes.
Advanced care planning Discuss goals of care and appropriate treatments based on those goals early in the disease process and re-evaluate these goals over time as the patient’s disease progresses.
Palliative care Consider referral to specialty-level palliative care when patients have refractory symptoms or when barriers to communication and advance care planning are encountered.
Palliation not withdrawal Effectively communicate with patients and their families that palliative care provides holistic person-centered care aimed at improving quality of life. It is not withdrawal of treatment and is not the same as hospice.
Symptom management Recognize and treat common heart failure symptoms and sources of distress including dyspnea, pain, fatigue, anxiety, insomnia, and depression.
Grief and bereavement Involve family members and caregivers in all plans of care to help them cope with the patient’s illness and reduce their risk of complicated bereavement.
Spiritual aspect Integrate spiritual care for patients to improve their quality of life and provide holistic care of the patient and family.
Device deactivation Discuss the option of device deactivation with patients with advanced illness as appropriate based on their goals and wishes for their health care.
Legal and ethical perspective Understand and explain to patients and families that device deactivation is neither assisted suicide nor euthanasia. It is legally and ethically permissible.