Cardiology’s underused tool: Skilled communication improves care for heart failure patients

Photo courtesy of Denise Bosco, 2018.

With more communication training, cardiologists and their teams could improve their patients’ outcomes and quality of life while possibly reducing readmissions and physician burnout.   

Communication between people living with a serious illness, such as heart failure, and clinicians is key to ensuring that care aligns with the patients’ wishes and improves their quality of life. But, despite a wealth of evidence that skilled communication can be learned, few cardiologists receive any formal training in it. Many clinicians feel uncomfortable discussing goals of care, breaking bad news and discussing prognoses, and they struggle to address patients’ emotional needs. As a result, patients often lack important information about their disease—including their  prognosis and common disease trajectories—and misunderstand their treatment options. Cardiologists and their teams, accustomed to being at the forefront of medical innovation, can take steps to improve their patients’ outcomes (and reduce physician burnout) by addressing this gap in their own training.   

Preparing for the road ahead

Most patients with heart failure, and their family caregivers, want candid information about what to expect and how to plan for an uncertain future. With specialized communication skills, cardiologists and advanced practice providers can help patients and families prepare for the difficult road ahead and meet these needs with appropriate treatment options. 

People living with heart failure face a progressive disease with an unpredictable trajectory and a heavy symptom burden of fatigue, breathlessness, pain and depression. Patients and their families must often make multiple complex treatment decisions as the illness advances, including whether to pursue high-intensity, invasive and costly interventions such as ventricular assist devices. And older adults with heart failure frequently have multiple comorbidities that complicate symptoms, prognosis and decision making. By effectively probing values and goals, cardiologists can partner with their patients to ensure that treatment decisions align with their patients’ wishes and unique reality. 

These conversations can inform questions about day-to-day symptom management to improve quality of life—such as how to treat episodic shortness of breath—as well as whether it is appropriate to pursue more aggressive and invasive procedures. They also can prepare patients and families for difficult decisions that often must be made at moments of high stress, such as during out-of-hospital cardiac arrest or CCU admission. When asked what is most important to them, even patients near the end of their disease process may identify something that their clinician can help them achieve: attending a grandchild’s graduation, for example, or simply sufficient relief from shortness of breath to get to the bathroom independently.  

Reducing hospitalizations

Preparing patients and caregivers for a sudden exacerbation could also help to keep them out of the hospital, a wish for many heart failure patients. Heart failure is the leading cause of hospital admissions among older adults, with 80 percent of Medicare beneficiaries with heart failure hospitalized in the last six months of life.

Health systems and risk-bearing organizations have an interest here, too, of course. A recent study—though not specific to heart failure—found that skilled communication between providers and patients was a significant factor in reducing readmissions (Harv Bus Rev 2015;9:5-8). The study analyzed six years of data from nearly 3,000 acute care hospitals. Hospitals that prioritized communication with patients (in addition to complying with evidence-based standards for care) reduced their readmission rates by 5 percent. Hospitals that focused on improving responses to patients’ needs with investments in other areas achieved only a 3 percent reduction in readmissions. 

Training to be better communicators

Cardiologists hoping to expand their communication skills can choose from a host of training courses, including those from Ariadne Labs, the Center to Advance Palliative Care and my own organization, VITALtalk. These three organizations recently launched a “Communication Skills Pathfinder,” an online portal to help clinicians, trainers and health systems navigate the options and choose the training model that best suits their needs.

Anthony Back, MD, is a professor of medicine in the division of oncology at the University of Washington, where he also co-directs the Cambia Palliative Care Center of Excellence. He cofounded VITALtalk, a nonprofit healthcare organization with the mission of scaling communication skills training for clinicians using a social entrepreneurship approach.