Exploring a Context-oriented Communication Algorithm for Advance Care Planning in Heart Failure

Background: The feasibility of a context-oriented communication algorithm for advance care planning (ACP) developed for terminal cancer patients has not yet been determined in heart failure (HF) in Korea. The purpose was to consolidate professional opinions regarding this communication model in HF. Methods: Using a panel of expert physicians in cardiovascular care, a three-round Delphi study was conducted for evaluation of this model along with Korean advance directives (K-AD). Results: A consensus was determined by a content validity ratio (CVRcritical) ≥0.318, a critical value for selection of an item scored as important (≥4 on a 5-point Likert scale). 50, 44, and 38 experts completed each round, respectively. Timing of ACP discussion is the most arguable with lacking in consensus on immediately after HF diagnosis across rounds (CVRs, from −0.80 to −0.83) while reaching consensus on an expectation of a terminal (CVR, from 0.60 to 0.78). Across three rounds, CVRs ranged moderately high for K-AD, ranging 0.59–0.91. Experts also reached a consensus on each five steps of a communication model: determinations of a patient decisional capacity, a patient's awareness, a patient's willingness for ACP, family dynamics, and a patient readiness for ACP. Conclusion: A context-oriented communication model with K-AD as a vehicle could be used to facilitate decision-making process for palliative and continuity of care in HF.