Knowledge and communication difficulties for patients with chronic heart failure: qualitative study

Objectives To explore patients' understanding of chronic heart failure; to investigate their need for information and issues concerning communication. Design Qualitative analysis of in-depth interviews by a constant comparativ e approach. Participants 27 patients identified by cardiology and care of the elderly p hysicians as having symptomatic heart failure (New York Heart Association f unctional class of II, III, or IV) and who had been admitted to hospital wi th heart failure in the past 20 months. Results Participants were aged 38-94 (mean 69 years); 20 had a New York Hea rt Association classification of III or IV. All had at least one concurrent illness. Participants sought information from the research interviewer abo ut their heart failure, their prognosis, and likely manner of death. They a lso described several factors that could inhibit successful communication w ith their doctors. These included difficulties in getting to hospital appoi ntments, confusion, short term memory loss, and the belief that doctors did not want to provide patients with too much knowledge. Conclusions Good communication requires the ability both to listen and to i mpart relevant information. Effective and better ways of communicating with patients with chronic heart failure need to be tested. Disease specific ba rriers to effective communication, such as short term memory loss, confusio n, and fatigue should be addressed. Strategies to help patients ask questio ns, including those related to prognosis, should be developed.