Barriers and Facilitators for Implementation of Palliative Care for Patients with Heart failure - a Rapid Synthesis of Reviews.

Abstract

Purpose of the review: While the benefits and need for integrating palliative care (PC) services into heart failure (HF) care have been well recognized, integration has been slow. Currently, only a small proportion of patients with HF utilize PC services, meaning there is a discrepancy between the knowledge about optimal care and the implementation of care. In recent years researchers have attempted to understand the barriers and facilitators of implementing PC models to patients with HF which has been captured in both primary, empirical research and secondary literature review papers. We aimed to synthesize these barriers and facilitators to the implementation of PC approaches for patients with HF within a well-known framework for assessing determinants of implementation, the consolidated framework for implementation research (CFIR).

Recent findings: We conducted a rapid synthesis of reviews using systematic review methods which sought to collate existing review articles pertaining to the research question. We used four search term categories: (1) Heart failure, (2) Palliative care, (3) Implementation, and (4) Review. We conducted searches in four databases (Scopus, EMBASE, CINAHL, COCHRANE) on the 1st of September 2025. We used the CFIR framework to synthesize the data. Firstly, we extracted key barriers and facilitators from the articles. We then categorized this information into sub-constructions of two of the CFIR's constructs (II. the Outer setting and III. The Inner setting). The search generated 2,080 results, of which 512 were duplicates. After screening, twenty-nine reviews were included in the data extraction and synthesis process. A range of barriers and facilitators were highlighted across the reviews. For the inner setting, this included a need for improving communication with patients and between healthcare professionals (HCPs) by engaging more openly and honestly about dying, an increase in joint working as part of multidisciplinary teams, funding and resource issues, and workforce recruitment and training issues. For the outer setting barriers and facilitators were associated with prognostic challenges and the complexity of caring for patients with HF, the needs of HF and geriatric patients, and the evidence and policy landscape associated with the principles of care and implementation of care for HF patients. Despite knowledge about the importance of PC, HCPs will struggle to integrate it into heart failure care unless they address practical, social, cultural, clinical, and economic determinants associated with care. By doing so, health care providers can develop implementation strategies for improving care.