The use of patient-reported outcome measures to demonstrate the effectiveness of palliative care interventions in heart failure patients: Insights from a hospice setting

Heart failure (HF) is a progressive condition associated with high symptom burden, declining function, and reduced quality of life. Although palliative care (PC) can address these multidimensional needs, evaluating its effectiveness in HF remains challenging due to the limited use of patient-reported outcome measures (PROMs) in non-malignant disease. This study examined the utility of the Integrated Palliative Care Outcome Scale (IPOS) in assessing the impact of PC interventions on symptoms, concerns, and goal attainment among HF patients receiving hospice care.

A mixed-methods design was used. Quantitatively, IPOS data from 214 hospice patients with HF were analysed at baseline and at six weeks. Descriptive statistics and sign tests was used to assess the changes across domains. Qualitatively, a random sub-sample of 50 patient records was reviewed using thematic analysis to explore expressed goals, achieved outcomes, and the interventions documented to support them.

At baseline, mobility and fatigue were the most burdensome symptoms. Significant improvements were observed in pain (p<0.001), breathlessness (p<0.001), and constipation (p=0.015), while fatigue, mobility, and psychosocial distress showed no meaningful change. In the qualitative subsample, 26% of patients achieved at least one goal. Goal attainment was more common among the 20% admitted for end-of-life care, where comfort-focused goals (pain relief, peacefulness, family presence) were more achievable than function-related goals. Outpatients, whose goals frequently centred on improving energy, mobility, and breathlessness, showed lower overall goal attainment.

IPOS proved valuable for identifying needs and monitoring selected outcomes in HF patients receiving PC. Improvements in physical symptoms contrast with persistent functional and psychosocial concerns. These unmet needs highlight the possibility that IPOS does not fully evaluate these needs in heart failure patients. Further prospective research is warranted to refine the role of IPOS in the functional and psychosocial needs of HF patients.