Enhancing Patient-Centered Home Palliative Care for Heart Failure: A Concept Analysis to Guide Nursing Practice and Care Coordination

Summary

This study analyzes and updates the home-based palliative care model for heart failure_, defining core components and proposing a refined_, nurse-centered framework that improves care coordination_, patient–family support_, and quality of life while guiding future research and clinical practice.

Abstract

To identify and describe components of the home-based palliative care model for patients with heart failure_, re-conceptualize the process_, and update the existing model to inform nursing research and clinical practice. Heart failure_, as a chronic progressive disease_, has a continuously increasing incidence and medical burden_, and requires multidimensional clinical management strategies. Although palliative care is recommended for improving the quality of life of heart failure patients_, its utilization rate is still low_, and the core components and implementation pathways of home-based palliative care are not yet clear. Using Rodgers' Evolutionary method_, a concept analysis was conducted to define the core components for home-based palliative care in heart failure. Data were drawn from professional literature spanning 1990 to 2025_, using the terms “home-based palliative care_,” “home palliative care_,” “home palliative treatment_,” “family hospice care_,” and “heart failure_,” “cardiac insufficiency_,” “congestive heart failure”. Abstracts from 101 articles were initially reviewed_, with 22 articles retained for analysis. Core concepts were identified_, defined_, and synthesized. The PRISMA 2020 checklist was used. The refined model clarifies nurses' roles in linking home-based palliative care core attributes: self-care_, collaborative palliative care_, communication of care goals_, and support. It presents patients'_, family caregivers'_, and healthcare workers' impact on home-based palliative care triggering_, implementation_, and outcomes_, emphasizing patient-centered continuous evaluation/adjustment. This model provides a structured framework to improve heart failure home care delivery and enhance patient/family quality of life_, with potential to inform home palliative care approaches for other chronic illnesses. Further refinement/adaptation is needed to ensure relevance across medical contexts.

Introduction

Heart failure (HF) is a chronic_, progressive condition and is the final stage of all cardiovascular diseases¹. Driven by the aging population and improved survival rates_, recent projections for the United States estimate a 46% increase in the prevalence of HF between 2012 and 2030. This rise is expected to drive healthcare costs upward by approximately 127%_, imposing a substantial economic burden on the global healthcare system². Patients with HF often suffer from a heavy symptom burden_, poor quality of life_, and repeated hospital admissions_, highlighting the need for more integrated clinical management approaches³. Palliative care is an approach aimed at improving the quality of life for individuals and their families' facing challenges associated with life-limiting diseases⁴. Numerous cardiology organizations have urged for the ongoing and earlier integration of end-of-life care for patients with advanced heart disease^5,6. Despite these recommendations_, utilization of palliative care among individuals with HF remains low_, with only approximately one-third receiving palliative care at the end-of-life^1,5,7.

Palliative care is currently available in multiple settings_, including home settings_, which facilitate a transition when their philosophical orientation corresponds with the objectives of both the patient and their family⁸. Home-based palliative care (HBPC) is a form of palliative care delivered by informal caregivers_, including family members_, along with a skilled interdisciplinary team comprising doctors_, nurses_, social workers_, and others in patients' homes⁹. Compared with inpatient or acute palliative care services_, HBPC is more appropriate for patients with low to moderate symptom burdens and provides continuity of care for those who are confined to their homes⁹. While recent research has described home-based palliative care for HF with an emphasis on daily living activities or symptom control in a home environment_, the essential elements of this care model for patients with HF who experience an unpredictable disease progression and require care in the home have not been well synthesized^3,10_,¹¹. Thus_, the purpose of this concept analysis is to identify and describe components of home-based palliative care in patients with HF (HBPC-HF).

The modern concept of palliative care was established in 1967 by Dr. Dame Cicely Saunders_, introducing her groundbreaking "Total Pain" framework at St. Christopher's Hospice¹². In 1969_, Dr. Elisabeth Kübler-Ross pioneered the examination of the psychological experiences of individuals nearing the end of life_, advocating for a holistic approach that addresses patients' and families' psychosocial and spiritual needs¹³. As medical practices evolved to a bio-psycho-social-spiritual model_, palliative care expanded from institutions to community and home settings¹⁴. This evolution has been driven by multidisciplinary teams_, telehealth advancements_, and a collective emphasis on improving the quality of life for terminally ill patients¹⁵.

In contrast to well-established protocols for cancer_, palliative care models for HF remain in evolution. One prevalent approach adapts the comprehensive interdisciplinary model of palliative care_, exemplified by initiatives such as the Core Pillars of the Model_, Palliative Advanced Home Care Model_, and HEARTFULL Model^3,16,17,18. These models allow HF patients to receive palliative care services from a full interdisciplinary team while simultaneously continuing curative treatments. These models_, however_, require strong organizational collaboration and a proficient workforce_, making them difficult to implement in resource-constrained regions^19,20. The advancement of telehealth technology presents a transformative approach to overcoming these challenges²¹. Through telehealth technology application in symptom management_, psychosocial support_, remote monitoring_, education_, and transitional care_, nurses significantly expand availability to high-quality_, resource-intensive support for patients^22,23,24. Therefore_, this study aimed to further understand the core elements of providing palliative care for HF patients in the home setting and how HBPC-HF can be achieved in clinical practice.

European guidelines define palliative care for HF as a multidisciplinary approach_, which is an integral part of the treatment for patients with HF²⁵. Its primary goal is to alleviate the physical_, psychological_, and spiritual distress experienced by patients and their caregivers_, and to improve the quality of life of individuals with severe illnesses^25,26. Currently_, the information on palliative care for HF in the literature focuses on introducing the key components and applications_, including alleviating symptoms associated with HF_, providing spiritual and psychological support to patients_, integrating support from a multidisciplinary care team_, and offering decision-making support^26,27,28. Meanwhile_, the guidelines also emphasize the importance of integrating palliative care early in the disease trajectory and across all stages of HF²⁵. Although palliative care for HF is gaining increasing recognition for its role in improving health outcomes_, particularly for patients in the advanced stages of the disease_, there is currently no clear and unambiguous definition of this concept.

Protocol

This research constitutes a concept analysis derived solely from existing literature and publicly accessible sources (including PubMed_, CINAHL_, Medline_, Embase_, Web of Science_, and Scopus). The study did not include the collection or analysis of individual patient data_, medical records_, CT scan data_, or any identifiable human information. Consequently_, ethical approval (IRB approval) and informed patient consent were not necessary for this study. No ethics committee review was sought_, in accordance with institutional and national research guidelines (Table of Materials).

Study design
This investigation applies Rodgers' evolutionary conceptual analysis methodology⁹. Emphasizing the evolution of concepts across time and contexts_, this approach deepens comprehension and highlights the progression of HBPC strategies for patients with HF. Key steps include contextualizing the primary concept_, identifying related concepts_, structuring them into a model_, and assessing the model's validity within theoretical frameworks^9,29.

Data sources and search strategy
Data were drawn from professional literature spanning 1990 to 2025_, including qualitative and quantitative studies_, reviews_, and book chapters. A comprehensive literature search was conducted across relevant databases_, including PubMed_, CINAHL_, Medline_, Embase_, Web of Science_, and Scopus_, to identify research addressing the concept of HBPC-HF. Search terms_, developed and refined with the support of a professional librarian_, included "home-based palliative care" and "heart failure_," along with related terms such as "cardiac insufficiency/congestive heart failure" and "home palliative care/home palliative treatment/family hospice care." The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were adhered to and implemented where applicable ³⁰. A total of 101 abstracts were screened for relevance_, from which 30 articles were identified and obtained for full-text assessment. Following the exclusion of 3 conference proceedings_, 5 case reports_, and 4 articles with unavailable full texts_, 18 publications focusing on HBPC-HF and 4 articles from reference lists were retained for inclusion (Figure 1). The final search was executed on 15 March 2025_, with the exact search string: ("home-based palliative care" OR "home palliative care" OR "home palliative treatment" OR "family hospice care") AND ("heart failure" OR "cardiac insufficiency" OR "congestive heart failure"). Search limits were applied to include only peer-reviewed_, English-language literature focused on adult (≥18 years) patient populations.

Study selection
All retrieved records underwent a two-stage screening process. The initial step involved reviewing titles and abstracts for their relevance to home-based palliative care in heart failure. Subsequently_, full-text articles were evaluated for eligibility. Conference abstracts_, case reports_, and articles lacking an accessible full text were excluded from the study. Research involving adult patients with heart failure who are receiving palliative care in home environments was deemed eligible for inclusion. Disputes concerning eligibility were addressed through dialogue and consensus. To mitigate potential bias from single-reviewer screening_, a 10% random sample of abstracts was independently dual-screened by a second reviewer_, with 100% inter-rater agreement; uncertain full-text eligibility was adjudicated via team consensus.

Data extraction
Data were systematically extracted from the included studies using a standardized extraction form created in Microsoft Excel. The extracted information encompassed the publication year_, study design_, definitions of home-based palliative care_, identified attributes_, antecedents_, consequences_, contextual factors_, and implications for nursing practice. This systematic method guaranteed uniformity and thoroughness in data collection throughout the studies.

Quality appraisal
The methodological quality of the studies included was evaluated utilizing the Joanna Briggs Institute (JBI) critical appraisal tools_, which were chosen based on the study design. Each study underwent assessment for methodological rigor_, clarity of reporting_, and relevance to the research objective. Only studies evaluated as moderate to high quality were included for synthesis to ensure the robustness of the conceptual analysis. A second independent reviewer verified quality ratings for 30% of included studies_, with no discrepancies in final quality categorization_, to minimize single-reviewer appraisal bias. Pre-specified quality thresholds were applied: studies were categorized as high quality if they met ≥80% of applicable JBI checklist criteria_, moderate quality if they met 50–79% of criteria_, and low quality if they met <50% of criteria.

Data synthesis and analysis
Data synthesis was performed using iterative comparison and thematic analysis_, following Rodgers' evolutionary method. Attributes_, antecedents_, and consequences were systematically compared across studies to discern patterns_, similarities_, and differences. The elements were integrated to develop a revised conceptual model of home-based palliative care for heart failure. The framework was refined through iterative review to ensure logical coherence and theoretical consistency.

Results

Overview of the concept
The included studies were rated as moderate to high quality using the Joanna Briggs Institute (JBI) critical appraisal tools31. After initial review and chronological sorting, the articles were examined in detail to extract definitions, attributes, antecedents, consequences, settings, and contextual factors, which were recorded in Excel. Screening, quality appraisal, and data extraction were conducted by a single reviewer, with bias-control procedures described in the Protocol...

Discussion

The early family palliative care framework was often limited in its application. When extended to HF_, models mainly focused on symptom management and were not adapted to the repeated fluctuations of the disease³. Under the existing models_, patients' autonomy is easily dominated by medical sites_, and patients are often forced to be hospitalized due to rigid treatment plans. Studies have shown that only 23% of patients with HF participate in communication about d...

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
PubMed	NCBI	https://pubmed.ncbi.nlm.nih.gov/	Biomedical literature search and citation database.
CINAHL	EBSCO Information Services.	https://www.ebsco.com/?utm_source=chatgpt.com	Nursing and allied health literature database.