Nurses' Attitudes and Perceptions Towards Heart Failure Palliative Care: A Mixed Method Systematic Review

Background/Objectives: Heart failure assistance is strictly correlated with the concept of palliative care. Supportive treatment should be part of the heart failure patient pathway from the beginning. Palliative care with interprofessional effective collaboration could be an important resource used to reduce heart failure distressing symptoms and improve quality of life. Nurses, as professionals with a holistic vision of care, play a crucial role in palliative care introduction and implementation. The aim was to explore nurses' attitudes and perceptions of heart failure palliative care, updating and adding knowledge to the current evidence. Methods: A systematic mixed-method review following the Joanna Briggs Institute methodology was undertaken. The screening of articles, data extraction and quality appraisal were performed by more than one author. The search was undertaken in May 2024 and applied to PubMed, Cinahl, Embase, Web of science, PsycInfo, Cochrane library and Scopus. A convergent integrated approach allowed us to combine qualitative and quantitative data. The analysis and synthesis of results was guided by the Theoretical Domain Framework. Results: Of the 1048 records identified, 26 met the inclusion criteria. Twelve framework domains were completed with data extracted. A flow chart was elaborated to offer an overview of the main concepts included. Conclusions: Numerous behaviors and elements influenced heart failure palliative care implementations. Analysis has shown that each analyzed element was strictly correlated one with another. When implementation was possible, outcome improvement sustained palliative care benefits with the direct involvement of nurses as educators and coordinators.