Communication and decision-making about prognosis in heart failure care

Background: Therapies to prolong life and improve quality of life for heart failure (HF) have expanded in both number and complexity. Clinicians, patients, and families are faced with an array of decisions about interventions with complex risks and benefits. Physicians must also discuss prognosis of HF and its inherent uncertainties. Methods and Results: This article applies knowledge of participatory decision-making and communication about prognosis from other health care settings to HF care. Strategies should generally follow an "ask-tell-ask" format, beginning with a patient's understanding of his or her H-F, identifying the information a patient desires, and then giving them small amounts of information at any given time, asking for feedback to clarify understanding. Conclusions: Despite the inherent uncertainty in individual outcomes with heart failure, physicians should discuss prognosis as desired by the patient or as needed to plan care, particularly when anticipated survival is shorter than I year. Exploring and reflecting patient responses and attending to their emotions can decrease patient anxiety and promote shared decision-making.