Prognosis, Communication, and Advance Care Planning in Heart Failure: A Module for Students, Residents, Fellows, and Practicing Clinicians

Publication ID Published Volume
10596 June 16, 2017 13

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Introduction: The increasing prevalence, high symptom burden, and medical advances that often prolong the advanced phase of heart failure mandate an organized and thoughtful approach to medical decision making. However, many clinicians have difficulty discussing prognosis and goals of care with patients. Barriers include disease- and therapy-specific prognostication challenges in heart failure and a lack of evidence-based primary palliative care education initiatives. Methods: In response, we developed this 45-minute training module, which consists of a case-based small-group session and a communication guide. The curriculum highlights prognostication challenges in heart failure and introduces an illness trajectory–based framework to cue iterative goals of care conversations. Results: We piloted this learning module with 46 internal medicine residents and interdisciplinary palliative care fellows in groups of three to 15 and obtained anonymous quantitative and qualitative postsession learner survey data to examine feasibility and acceptability. Trainees rated the session highly. One hundred percent of learners either strongly agreed or agreed the session was clinically useful. Learners unanimously found the teaching methods effective, and most felt they could easily apply these skills to their clinical work. In open-ended feedback, learners said the session gave them a better understanding of the heart failure illness trajectory, an improved framework for discussing goals of care with heart failure patients, and specific language to use when having these discussions. Discussion: This module represents a new paradigm for teaching both prognostication and advance care planning in heart failure in which illness trajectory guides timing and content of goals of care conversations.


Zehm A, Lindvall C, Parks K, Schaefer KG, Chittenden E. Prognosis, communication, and advance care planning in heart failure: a module for students, residents, fellows, and practicing clinicians. MedEdPORTAL Publications. 2017;13:10596.

Educational Objectives

By the end of this session, learners will be able to:

  1. Describe how prognosis in advanced heart failure is highly variable and uncertain but illness trajectory is more predictable and clinically useful.
  2. Illustrate the trajectory of illness in heart failure and use this model to promote disease understanding amongst patients and families.
  3. Demonstrate communication skills and strategies to discuss illness trajectory and advance care planning tailored to a patient’s stage of illness.


  • Prognosis, Serious Illness, Communication, Care Goals, Patient Care Planning, Heart Failure, Advance Care Planning, Palliative Care, Case-Based Learning, Small Group


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