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Friday, 8 September, 2000, 00:42 GMT 01:42 UK
Seriously ill 'don't get full facts'
Heart monitor
Heart patients felt doctors did not communicate properly
Doctors fail to communicate effectively with patients who suffer from chronic heart failure and want to know the full facts about their condition, say researchers.

A study, published in the British Medical Journal, found that patients often feel unable to ask their doctors questions about their illness.

They also believe that doctors are reluctant to provide them with too much knowledge.


There are numerous benefits in more open communication about prognosis

King's and St Thomas' Medical School researchers

The researchers say more effective communication between doctors and their patients is urgently needed.

Twenty seven chronic heart failure patients aged 38-94 were interviewed about the effect their condition had on their everyday lives.

Most patients lacked a clear understanding of why they had developed heart failure, what it was, and what this implied for them.

Many felt that their symptoms were a result of growing older and believed that nothing could be done.

Although some patients were apparently unaware of their likely prognosis, most patients saw death as inevitable, but felt that doctors were reluctant to talk about death or dying.

One patient stated: "I think they like to keep things away from the patient."

The researchers warn that some patients may benefit from more open communication about death and dying.

They call for the development of strategies to help patients ask questions - particularly as chronic heart failure has a worse prognosis than many cancers.

Reluctant to talk

The researchers, led by Dr Angela Rogers, of King's and St Thomas' Medical School, London, issued a statement to BBC News Online in which they said: "Doctors may be reluctant to talk to patients about their likely prognosis because of the lack of certainty of when an individual patient would be likely to die.

"Talking about death and dying is difficult. It's a taboo subject generally in society and may be particularly difficult in a busy health care setting where it is crowded and there isn't a lot of time."

The researchers said doctors and nurses may not have received adequate or appropriate training in this area.

In addition, health care professionals may not wish to distress patients and may have concerns about coping with distressed patients.

"There are numerous benefits in more open communication about prognosis.

"Sometimes people have fears or concerns that their doctors and nurses haven't thought of, and they want to discuss these, for example symptom control, preferences for place of care, the likely manner of death or provision for the future."

Lifestyle issues

Dr Vivienne Press, Assistant Medical Director at the British Heart Foundation (BHF), said: "Many people with heart failure could be helped to live longer and enjoy a better quality of life if they had optimal treatment and received advice on lifestyle issues such as physical activity and diet.

"There is a need for increased numbers of specialist heart failure nurses to deliver this care and also palliative care for those with very severe heart failure."

The BHF has 18 booklets in its Heart Information Series which are distributed free to GP surgeries.

Modern treatments for heart failure slow the but do not stop the disease progress.

Recent research indicates that 38% of newly diagnosed heart failure patients will die within 12 months and 43% within 18 months.

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See also:

18 Apr 00 | Health
Heart patients 'not consulted'
08 Mar 00 | Health
GPs' bedside manner targeted
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