The concerns of patients under palliative care and a heart failure clinic are not being met

Patients with a terminal illness, identified by palliative care teams worki ng in Manchester, and patients attending a heart failure clinic, were asked to participate in a prospective survey to determine their main concerns. D ata were collected from 213 palliative care (PC) patients (mostly with canc er) and 66 patients with heart failure (HF). The median ages of the two pat ient groups were similar, but the HF patients were more likely to be male a nd living with a partner; 13% of PC and 7% of HF patients reported that the y had no carer. The PC patients had more district nurse, hospice, social wo rk and physiotherapy input. The most frequently reported troublesome problems for PC patients were pain (49%), loss of independence (30%) and difficulty walking (27%). HF patient s reported dyspnoea (55%), angina (32%) and tiredness (27%) as the most tro ublesome problems. From a checklist of symptoms, the frequency of tiredness (PC = 77%, HF = 82%) and difficulty getting about (PC = 71%, HF = 65%) wer e high in each group. Psychological problems were reported by 61% of PC and 41% of HF patients. Cardiac patients reported more breathlessness and coug h than PC patients (83% vs 49% and 44% vs 26%, respectively). Reduced libid o was more common in cardiac patients (42% vs 21%). Patient disclosure of troublesome problems to professional carers was high (>87% in both PC and HF patients). Documented action was greater for physic al than social or psychological problems. For PC patients, documented actio n was recorded for 83% physical, 43% social/functional and 52% psychologica l problems. For HF patients documented action was recorded for 74% cardiac, 60% physical - non-cardiac, 30% social/functional and 28% psychological pr oblems. Clearly many patients' troublesome problems were not being addresse d. As a result of this study, specific action by health care professionals was taken in 50% of PC patients and 71% of HF patients. We plan to target spec ific educational events on the treatment of physical problems, psychologica l assessment and social service provision.