Components of home-based supportive care for adult patients with heart failure: a scoping review protocol
Creators: name: Sameera Senanayake
name: Yates, Patsy
name: Parsonage, William
name: Sanjeewa Kularatna
name: Emmanuwelge Madhurangi (Madhu) Perera
name: Halahakone, Dona Ureni Kashinka
name: Gursharan Singh
Publisher: name: Open Science Framework
Year: 2023
Subjects: subject: Medicine and Health Sciences
subject: home-based
subject: supportive care
subject: heart failure
subject: palliative care

description: Scoping review objective The objective of this scoping review is to identify and map the components of home-based supportive care for adult patients with chronic heart failure. Scoping review question What are the components of home-based supportive care for adult patients with chronic heart failure? Background/ Introduction Defined as a global health pandemic, heart failure (HF) affects over 26 million worldwide and continues to increase due to ageing population and advancement of therapies, adding a burden to individuals, families and the economy. Optimising care for patients with HF remains challenging with high mortality, morbidity and health care expenditure. Early access and utilization of supportive care (a component of palliative care) is recommended for patients with HF and the home setting is a preferred and explored setting of care in achieving palliative care goals because it improves the outcomes of care for HF patients and is reported to reduce costs incurred due to hospitalizations. A systematic review and meta analysis reported the benefits of palliative care in the home setting for patients with heart failure. Home-based care when provided in a timely, integrated manner and with a patient centred focus, can improve the health care related quality of life also aiding in reducing health care costs. The definitions of the key terms for the proposed scoping review are described below. Definitions Supportive care The term ‘supportive care’ has been used interchangeably with the term ‘palliative care’. The World Health Organization (2020) defines palliative care as “an approach that improves the quality of life of patients and their families who are facing problems associated with life-threatening illnesses. It prevents and relieves suffering through the early detection, correct assessment and treatment of pain and other problems, whether physical, psychosocial, or spiritual”. A systematic review by Hui and colleagues (2013) with the objective to distinguish between the terms ‘palliative care’, ‘hospice care’ and ‘supportive care’ revealed that the timing and type of care provided varies with the terminology used. While ‘palliative care’ is associated with advanced stages of disease, ‘hospice care’ involves care provided around the time of death and bereavement. The term ‘supportive care’ provides a wider range of services starting from an early onset of disease through advanced disease. Hui states that there is less clarity among the services provided in the context of supportive care and are mainly hospital-based. In addition, ‘supportive care’ is associated with less stigma. This proposed review will include literature which refers to care and services provided from an early onset of disease through advanced disease (supportive care) and also includes palliative care (care in the advanced stage of disease only). Home-based care Home-based care can vary from a house call by a health care provider for prevention of falls to providing of palliative care. For the planned scoping review, care provided at the home setting by a health care provider, including but not limited to tele-health services is/will be considered as home-based care. A working group by the World Health Organization in 2000 presented a list of essential components of ‘home-based long term care’ which comprised of 31 items that ranged from providing essentials (food/ shelter) to provision of palliative care, covering a broad spectrum of recipients. Though comprehensive, the specific needs and wants of HF patients which require palliative care were not addressed. Stromberg and colleagues (2011) conducted a literature review, examining the components of HF management in the home setting, irrespective of the outcomes and effectiveness of the perused studies. Patients needing palliative care was amiss. Similarly, a scoping review by Hofmeister and colleagues (2018), reported primary outcomes in palliative care in the home-setting and the quality of these studies, did not report on the components of care in home-setting, nor included patients with HF. Due to the unpredictable disease trajectory of HF, the care needed by HF patients differ to that of patients with malignant diseases. Exploring the components of such care in the home-setting require special consideration. Despite availability of literature on elements of home-based long-term care in the context of primary care, components of palliative care at home and studies on HF management in the home-setting, studies on the components of supportive care for HF patients in the home setting are scarce. A preliminary search conducted in PubMed, Embase and Cochrane databases did not reveal any relevant reviews on the proposed topic. A scoping review perusing current literature will identify underpinnings of supportive care in the home setting and aid in mapping the available literature on the topic. The findings will map the components of home-based supportive care for patients with HF and further aid in understanding key concepts in ‘home-based supportive care in heart failure’. The results may provide information for implementation of future interventions in this arena. As mentioned above, understanding components of home-based supportive care for patients with HF provides an opportunity to improve access to supportive care for this population, as home-based supportive care has the potential to improve symptom management and function, taking into consideration the patient’s way of life. Inclusion and exclusion criteria Scope of this review will include all relevant literature on the following; Types of participants All adult populations (18 years and above) with HF will be included irrespective of sex, socio-demographic status and co-morbidities. Exclusion : Patients awaiting/undergone heart transplant will be excluded from this review as they are a niche group with specific requirements and that services are already in place for this group. Concept The review will map the components relevant to home-based supportive care in patients with heart failure. Context Home-based supportive care provided for heart failure patients will be considered. The review will not be limited by geographic location. Exclusion: Review restricted to sources published in English. Types of Sources As the review question is broad in nature, exploring components for care, sources for this review will be open. Some of the ‘open’ sources may include qualitative and quantitative studies, policy guidelines and documents and grey literature. All relevant literature published in English, irrespective of the time of publication will be included in this scoping review.