Abstracts
Résumé
L’insuffisance cardiaque (IC) est une maladie chronique complexe, touchant plus de 300 000 Canadiens, qui évolue vers une phase terminale. Le taux de mortalité s’élève à 50 % dans la première année suivant le diagnostic d’IC de stade IV. L’émergence des soins palliatifs a permis de centrer les soins sur la qualité de vie, le soulagement de la douleur et des symptômes en fin de vie. Plusieurs études relatent que les personnes atteintes d’IC à un stade avancé présentent des symptômes similaires aux personnes atteintes de cancer. Cependant, les personnes qui bénéficient des soins palliatifs sont surtout celles atteintes de cancer. Un centre de cardiologie tertiaire de la région de Montréal a implanté une approche intégrée de soins curatifs et palliatifs pour la clientèle IC. La trajectoire particulière de l’IC rend complexe et essentiel le développement d’une approche intégrée de soins curatifs et palliatifs pour maximiser la qualité de vie des personnes atteintes d’IC en fin de vie.
Mots clés:
- insuffisance cardiaque,
- intégration des soins,
- soins palliatifs,
- programme de soins hospitaliers
Abstract
Heart failure (HF) is a chronic and incurable disease evolving toward a terminal phase. More than 300 000 Canadians suffered from HF. Patients with a severe form of HF (phase IV, according to the New York Heart Association) have a one year survival of 50 %. Palliative care has been extensively developed over the last years for the benefit of the cancer patient, these cares emphasizes a biopsychosocial approach that includes quality of life, pain control and symptoms relief at the end of life. Unfortunately, palliative care is rather poorly offered to the people suffering from a non malignant condition. Many authors stated that the symptoms of HF failure patients are quite similar to those observed for palliative cancer patients. The Montreal Heart Institute (MHI) has integrated a palliative care approach according to the Quebec policy on palliative care. This palliative care approach contributes to the quality of care and promotes the patients and clinicians satisfaction.
Keywords:
- heart failure,
- integrated care,
- palliative care,
- hospital care program
Download the article in PDF to read it. Download
Appendices
Bibliographie
- ADDINGTON-HALL, J.M., L.D. MacDONALD, H.R. ANDERSON, J. CHAMBERLAIN, P. FREELING, J.M. BLAND et J. RAFFERTY (1992). « Randomised controlled trial of effects of coordinating care for terminally ill cancer patients », British Medical Journal, no 305, p. 1317-1322.10.1136/bmj.305.6865.1317 Google Scholar Search this bibliographic reference on Google Scholar
- ALBERT, N., D. MELLAR et J. YOUNG (2002). « Improving the care of patients dying of heart failure », Cleveland Clinic Journal of Medicine, no 69, p. 321-328.10.3949/ccjm.69.4.321 Google Scholar Search this bibliographic reference on Google Scholar
- ANDERSON, H., C. WARD, A. EARDLY, S.A. GOMM, M. CONNOLLY, T. COPPINGER, D. CORGIE, J.L. WILLIAMS et J.L. MAKIN (2001). « The concerns of patients under palliative care and a heart failure clinic are not being met », Palliative Medicine, no 15, p. 279-286.10.1191/026921601678320269 Google Scholar Search this bibliographic reference on Google Scholar
- BEAUCHAMP, T.L. et J.F. CHILDRESS (1994). The Principles of Biomedical Ethics, 4e édition, Oxford, Oxford University Press.10.1007/s005200100290 Google Scholar Search this bibliographic reference on Google Scholar
- BORBASI, S., Y. CHAPMAN et K. WOTTON (2002). A Work in Progress : Nurses’ Perceptions on Caring for End-of-Life Heart Failure Patients in Community and Hospital Settings, Adelaide, Flinders University.10.1191/026921698677822456 Google Scholar Search this bibliographic reference on Google Scholar
- BOWLING, A. (1995). Measuring Disease, Buckingham, Open University Press.10.1093/acprof:oso/9780198509332.001.0001 Google Scholar Search this bibliographic reference on Google Scholar
- BUTOW, P.N., S. DOWSETT, R. HAGERTY et M. TATTERSALL (2002). « Communicating prognosis to patients with metastatic disease : What do they really want to know ? », Supportive Care Cancer, no 10, p. 161-168.10.1007/s005200100290 Google Scholar Search this bibliographic reference on Google Scholar
- CAMPBELL, M.L. (1996). « Program assessment through outcomes analysis : Efficacy of a comprehensive supportive care team for end-of-life-care », American Association of Critical Care Nurses, Clinical Issues, n° 7, p. 159-167.10.1136/bmj.325.7364.581 Google Scholar Search this bibliographic reference on Google Scholar
- DAVIES, N. et M. CURTIS (2000). « Providing palliative care in end-stage heart failure », Professional Nurse, no 15, p. 389-392.10.1191/026921698676226729 Google Scholar Search this bibliographic reference on Google Scholar
- DEATON, C. et K.L. GRADY (2004). « State of the science for cardiovascular nursing outcomes – Heart failure », Journal of Cardiovascular Nursing, no 19, p. 329-338.10.1111/j.0889-7204.2001.00580.x Google Scholar Search this bibliographic reference on Google Scholar
- DÉCARIE, S. (2005). Développement d’une approche intégrée de soins curatifs et palliatifs aux personnes atteintes d’insuffisance cardiaque en centre hospitalier, Rapport de stage de maîtrise inédit, Faculté des sciences infirmières, Université de Montréal.10.1016/S0885-3924(01)00406-7 Google Scholar Search this bibliographic reference on Google Scholar
- DOYON, O. (2002). Soins infirmiers cardiovasculaires 1 et 11, document inédit, Université du Québec à Trois-Rivières.10.1191/0269216304pm893oa Google Scholar Search this bibliographic reference on Google Scholar
- DUCHARME, A. (1999). « La défaillance cardiaque : Le diagnostic au cabinet », Le médecin du Québec, no 34, p. 63-73.10.1136/heart.87.3.235 Google Scholar Search this bibliographic reference on Google Scholar
- EDMONDS, P.M., J.M. STUTTAFORD, J. PENNY, A.M. LYNCH et J. CHAMBERLAIN (1998). « Do hospital palliative care teams improve symptom control ? Use of a modified STAS as an evaluation tool », Palliative Medicine, no 12, p. 345-351.10.1191/026921698677822456 Google Scholar Search this bibliographic reference on Google Scholar
- ELLERSHAW, J. et S. WILKINSON (2003). Care of the Dying : A Pathway to Excellence, Oxford, Oxford University Press.10.1093/acprof:oso/9780198509332.001.0001 Google Scholar Search this bibliographic reference on Google Scholar
- FAISINGER, R., K. FASSBENGER, C. BRENNEIS, P. BROWN, T. BRAUN, C. NEUMANN, A. VIGANO, J. HATCHER et P. JACOBS (2003). Évaluation économique de deux programmes régionaux de soins palliatifs pour les cancéreux en phase terminale, Otttawa, Fondation canadienne de la recherche sur les services de santé.10.1136/bmj.325.7370.929 Google Scholar Search this bibliographic reference on Google Scholar
- FAULL, C. et R. WOOF (2002). Palliative Care : An Oxford Core Text, Oxford, Oxford University Press.10.1191/0269216304pm837oa Google Scholar Search this bibliographic reference on Google Scholar
- FERRIS, F.D., H.M. BALFOUR, K. BOWEN, J. FARLEY, M. HARDWICK, C. LAMONTAGNE, M. LUNDY, A. SYME et P. WEST (2002). Modèle de guide des soins palliatifs : Fondé sur les principes et les normes de pratique nationaux, Ottawa, Association canadienne de soins palliatifs.10.1136/bmj.316.7127.286 Google Scholar Search this bibliographic reference on Google Scholar
- FINUCANE, T. E. (2002). « Care of patients nearing death : Another view », Journal of American Geriatric Society, no 50, p. 551-553.10.1046/j.1532-5415.2002.50125.x Google Scholar Search this bibliographic reference on Google Scholar
- GOODLIN, S.J., P.J. HAUPTMAN, R. ARNOLD, K. GRADY, R.E. HERSHBERGER, J. KUTNER, F. MASOUDI, J. SPERTUS, K. DRACUP, J.F. CLEARY, R. MEDAK, K. CRISPELL, P. ILEANA, B. STUART, C. WHITNEY, T. RECTOR, J. TENO, et D.G RENLUD (2004). « Consensus statement : Palliative and supportive care in advanced heart failure », Journal of Cardiac Failure, no 10, p. 200-204.10.1053/euhj.2001.2783 Google Scholar Search this bibliographic reference on Google Scholar
- GREEN, L.W. et M.W. KREUTER (1999). Health Promotion Planning : An Educational and Environmental Approach, 3e éd., Toronto, Mayfield.10.1001/jama.281.2.163 Google Scholar Search this bibliographic reference on Google Scholar
- HANRATTY, B., D. HIBBERT, F. MAIR, C. MAY, C. WARD, S. CAPEWELL, A. LITVA et G. CORCORAN (2002). « Doctors’ perceptions of palliative care for heart failure : Focus group study », British Medical Journal, no 325, p. 581-585.10.1136/bmj.325.7364.581 Google Scholar Search this bibliographic reference on Google Scholar
- HEARN, J. et I.J. HIGGINSON (1998). « Do specialist palliative care teams improve outcomes for cancer patients ? A systematic literature review », Palliative Medicine, no 12, p. 317-332.10.1191/026921698676226729 Google Scholar Search this bibliographic reference on Google Scholar
- HENDRICK, A. (2001). « Cost-effective outpatient management of persons with heart failure », Progress in Cardiovascular Nursing, no 16, p. 50-56.10.1111/j.0889-7204.2001.00580.x Google Scholar Search this bibliographic reference on Google Scholar
- HIGGINSON, I.J., I. FINLAY, D.M. GOODWIN, A.M. COOK, K. HOOD, A.G.K. EDWARDS, H.-R. DOUGLAS et C.E. NORMAN (2002). « Do hospital-based palliative teams improve care for patients or families at the end of life ? », Journal of Pain and Symptom Management, no 23, p. 96-106.10.1016/S0885-3924(01)00406-7 Google Scholar Search this bibliographic reference on Google Scholar
- HORNE, G. et S. PAYNE (2004). « Removing the boundaries : Palliative care for patients with heart failure », Palliative Medicine, no 18, p. 291-296.10.1191/0269216304pm893oa Google Scholar Search this bibliographic reference on Google Scholar
- HUGHES, S.L., J. CUMMINGS, F. WEAVER, L. MANHEIM, B. BRAUN et K. CONRAD (1992). « A randomized trial of the cost effectiveness of VA hospital-based home care for the terminally ill », Health Services Research, no 26, p. 801-817.10.1097/00044067-199602000-00015 Google Scholar Search this bibliographic reference on Google Scholar
- JUENGER, J., D. SCHELLBERG et S. KRAEMER (2002). « Health related quality of life in patients with congestive heart failure : Comparison with other chronic diseases and relation to functional variables », Heart, no 87, p. 235-241.10.1136/heart.87.3.235 Google Scholar Search this bibliographic reference on Google Scholar
- KRUMHOLZ, H.M., R.S. PHILLIPS, M.B. HAMEL, J.M. TENO, P. BELLAMY, S.K. BROSTE, R.M. CALIFF, H. VIDAILLET, R.B. DAVIS, L.H. MUHLBAIER, A.F. Jr. CONNORS, J. LYNN et L. GOLDMAN (1998). « Resuscitation preferences among patients with severe congestive heart failure : results from the SUPPORT project. Study to understand prognoses and preferences for outcomes and risks of treatments », Circulation, no 98, p. 648-655.10.1097/00005082-200409000-00008 Google Scholar Search this bibliographic reference on Google Scholar
- KUTNER, J.S., J.E. KASSNER et D.E. NOWELS (2001). « Symptom burden at the end of life : Hospice providers’ perceptions », Journal of Pain and Symptom Management, no 21, p. 473-480.10.1016/S0885-3924(01)00281-0 Google Scholar Search this bibliographic reference on Google Scholar
- LAMBERT, P. et H. LECOMPTE (2000). Le citoyen : une personne du début… à la fin. Rapport sur l’État de la situation des soins palliatifs au Québec, Québec, Ministère de la Santé et des Services sociaux.Google Scholar Search this bibliographic reference on Google Scholar
- LEVENSON, J.W., E.P. McCARTY, J. LYNN, R.B. DAVIS et R.S. PHILLIPS (2000). « The last six months of life for patients with congestive heart failure », Journal of American Geriatric Society, no 48, p. S101-S109.Google Scholar Search this bibliographic reference on Google Scholar
- LYNN, J., J. L. SCHUSTER et A. KABCENELL (2000). Improving Care for the End of Life, Oxford, Oxford University Press.Google Scholar Search this bibliographic reference on Google Scholar
- LYNN, J., J. TENO et P. RUSSELL (1997). « Perceptions by the family of the dying experience of older and seriously ill patients », Annals of Internal Medicine, no 126, p. 97-106.Google Scholar Search this bibliographic reference on Google Scholar
- McCARTHY, M., J. ADDINGTON-HALL et J. LAY (1997). « Communication and choice in dying from heart disease », Journal of the Royal Society of Medicine, no 90, p. 138‑131.Google Scholar Search this bibliographic reference on Google Scholar
- McCARTHY, M., M. LAY et J. ADDINGTON-HALL (1996). « Dying from heart disease », Journal of the Royal College of Physicians of London, no 30, p. 325-328.10.1016/j.cardfail.2003.09.006 Google Scholar Search this bibliographic reference on Google Scholar
- McMURRAY, J.J. et S. STEWART (2000). « Epidemiology, aetiology and prognosis of heart failure », Heart, no 83, p. 596-602.10.1136/heart.83.5.596 Google Scholar Search this bibliographic reference on Google Scholar
- MEIER, D.E. (2002). « Overview of cancer pain and palliative care », Journal of Pain and Symptom Management, no 24, p. 97-106.Google Scholar Search this bibliographic reference on Google Scholar
-
Ministère de la Santé et des Services sociaux (2004). Politique en soins palliatifs de fin de vie, Québec, Ministère de la Santé et des Services sociaux.10.1161/01.CIR.98.7.648 Google Scholar Search this bibliographic reference on Google Scholar
-
Ministère de la Santé et des Services sociaux (1998). Registre des événements démographiques du Québec, fichier des décès, Unité d’études et d’analyses, Québec, Ministère de la Santé et des Services sociaux.Google Scholar Search this bibliographic reference on Google Scholar
- MOSER, D.K. et P.I. WORSTER (2000). « Effect of psychosocial factors on physiologic outcomes in patients with heart failure », Journal of Cardiovascular Nursing, no 14, p. 106-115.10.1111/j.1532-5415.2000.tb03119.x Google Scholar Search this bibliographic reference on Google Scholar
- MURRAY, S.A., K. BOYD, M. KENDALL, A. WORTH, T.F. BENTON et H. CLAUSEN (2002). « Dying of lung cancer or cardiac failure : Prospective qualitative interview study of patients and their carers in the community », British Medical Journal, no 325, p. 929-933.10.1136/bmj.325.7370.929 Google Scholar Search this bibliographic reference on Google Scholar
- MURRAY, S.A., M. KENDALL, K. BOYD, A. WORTH et T.F. BENTON (2004). « Exploring the spiritual needs of peoples dying of lung cancer or heart failure : A prospective qualitative interview study of patients and their careers », Palliative Medicine, no 18, p. 39-45.10.1191/0269216304pm837oa Google Scholar Search this bibliographic reference on Google Scholar
- O’BRIEN, T., J. WELSH et F.G. DUNN (1998). « ABC of palliative care : Non-malignant conditions », British Medical Journal, no 16, p. 286-289.10.1136/bmj.316.7127.286 Google Scholar Search this bibliographic reference on Google Scholar
- PANTILAT, S.Z. et A.E. STEIMLE (2004). « Palliative care for patients with heart failure », Journal of American Medical Association, no 26, p. 2476-2482.10.1001/jama.291.20.2476 Google Scholar Search this bibliographic reference on Google Scholar
-
Régie régionale de la santé et des services sociaux de Montréal-Centre (1999). Les réseaux des services de santé de première ligne : le cas des services dispensés aux personnes atteintes d’insuffisance cardiaque dans le Sud-Ouest de Montréal : rapport descriptif, Montréal, Régie régionale de la santé et des services sociaux de Montréal-Centre, Direction de la santé publique.10.1016/S0885-3924(02)00453-0 Google Scholar Search this bibliographic reference on Google Scholar
- REMME, W.J. et K. SWEDBERG (2001). « Guidelines for the diagnosis and treatment of chronic heart failure », European Heart Journal, no 22, p. 1527-1560.10.1053/euhj.2001.2783 Google Scholar Search this bibliographic reference on Google Scholar
- RILEY, J. et L. BLUE (2001). « Assessing and managing chronic heart failure », Professional Nurse, no 16, p. 1112-1115.Google Scholar Search this bibliographic reference on Google Scholar
- SAUNDERS, C. (1999). « Pain and impending pain », dans P. WALL et R. MELZACK (dir.), Textbook of Pain, 2e édition, Londres, Churchill Livingstone.10.1097/00005082-200007000-00008 Google Scholar Search this bibliographic reference on Google Scholar
- SINGER, P.A., D.K. MARTIN et M. KELNER (1999). « Quality end-of-life care patient’s perspectives », Journal of American Medical Association, no 281, p. 163-168.10.1001/jama.281.2.163 Google Scholar Search this bibliographic reference on Google Scholar
- STEINHAUSER, K., N.A. CHRISTAKIS, E.C. CLIPP, M. McNEILLY, S. GRAMBOW, J. PARKER et J.A. TULSKY (2001). « Preparing for the end of life : Preferences of patients, families, physicians, and other care providers », Journal of Pain and Symptom Management, no 22, p. 727-737.10.1016/S0885-3924(01)00334-7 Google Scholar Search this bibliographic reference on Google Scholar
- VINEY, L.L., B.M. WALKER, T. ROBERTSON, B. LILLEY et C. EWAN (1994). « Dying in palliative care units and in hospital : A comparison of the quality of life of terminal cancer patients », Journal of Consulting Clinical Psychology, no 62, p. 157-164.10.1037/0022-006X.62.1.157 Google Scholar Search this bibliographic reference on Google Scholar
- WOTTON, K., S. BORBASI et M. REDDEN (2005). « When else has failed : Nurses’ perception of factors influencing palliative care for patients with end-stage heart failure », Journal of Cardiovascular Nursing, no 20, p. 18-25.10.1097/00005082-200501000-00006 Google Scholar Search this bibliographic reference on Google Scholar