Spirituality and suffering of patients with heart failure

摘要

Heart failure is the terminal stage of cardiac disease and, as such, potentially involves spiritual issues and suffering. Spirituality has been shown to be related to adaptation, life satisfaction, and depression. Further, as depression is an independent predictor of mortality in patients with heart failure, spirituality is important for clinicians to consider. Patients with heart failure are disadvantaged compared to patients with other terminal diseases. The heart failure illness trajectory is unpredictable and the potential for sudden, unanticipated death exists. The management of end-stage heart failure is often associated with distressing symptoms, multiple hospitalizations and the potential for suffering. Patients are often less likely to understand their illness, have access to supportive care and have the opportunity to plan for death and dying. Unmet spiritual needs and suffering may go under diagnosed and treated. This suggests the need for a more palliative approach emphasizing the optimization of multidimensional life satisfaction and the relief of suffering. The purpose of this article is to focus primarily on spirituality and suffering, spiritual needs, and related interventions for patients living (and potentially suffering) with heart failure. Traditionally, care has been focused on meeting the physical suffering needs of patients, such as breathlessness, pain and fatigue, and to prolong life. Current thinking needs to shift to include the assessment of the psychological, social and spiritual needs and to improve life satisfaction. Interventions that have been developed for other chronic, terminally ill patients are described and new, potentially helpful interventions are proposed.