Hindawi

Emergency Medicine International

Volume 2022, Article ID 8687074, 6 pages
https://doi.org/10.1155/2022/8687074

Research Article
Application of Semistructured Interview Based on Doctor-Patient
Perspective in Constructing a Palliative Care Regimen for
Patients with Advanced Heart Failure

Ting Zhou , HaiQin Cai, and ChunHui Xu

Department of Cardiovascular Medicine, Linping Campus,
The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 311100, China

Correspondence should be addressed to Ting Zhou; [email protected]

Received 12 April 2022; Accepted 30 May 2022; Published 18 June 2022

Academic Editor: Weiguo Li

Copyright © 2022 Ting Zhou et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Objective. The aim of this study is to explore the application of semistructured interview based on doctor-patient perspective in
constructing a palliative care regimen for patients with advanced heart failure. Methods. 112 patients with advanced heart failure
who were admitted to the hospital were selected between December 2019 and December 2020, and they were randomly divided
into an interview group and a routine group, with 56 cases in each group. The routine group was given routine nursing for
advanced heart failure while the interview group developed a palliative care regimen based on a semistructured interview from the
doctor-patient perspective. The psychological states (Depression-Anxiety-Stress Scale (DASS-21)), symptoms (Memorial
Symptom Assessment Scale-Heart Failure (MSAS-HF)), quality of life (Kansas City Cardiomyopathy Questionnaire (KCCQ)),
and prognosis (readmission rate, mortality rate) were compared between the two groups before and after intervention. Results.
Compared with before intervention, there were no significant differences in the scores of DASS-21, MSAS-HF, and KCCQ in the
routine group after intervention (P > 0.05), and the scores of DASS-21 and MSAS-HF in the interview group were decreased while
KCCQ scores were increased (P < 0.05). Scores of DASS-21 and MSAS-HF and readmission rate were lower while the KCCQ
scores were higher in the interview group compared with those in the routine group (P < 0.05). There was no significant difference
in the mortality rate between the two groups (P > 0.05). Conclusion. The application of a semistructured interview based on the
doctor-patient perspective to construct the palliative care regimen for patients with advanced heart failure can eliminate the
negative emotions, improve the psychological states, relieve the clinical symptoms, enhance the quality of life, and reduce the risk
of readmission.

1. Introduction persistent physical symptoms can induce psychological

symptoms such as anxiety and depression, so based on what
Various cardiovascular diseases can eventually develop into patients need, they are often given palliative care, such as
heart failure, which is the end stage of various cardiovascular covering all aspects of physical symptom control, psycho-
diseases that can lead to myocardial remodeling such as logical intervention, etc. [3] However, how to fully grasp the
myocardial infarction [1]. Heart failure is a kind of nonc- needs of patients, build an effective palliative care plan,
urable disease, and the primary purpose of treatment and relieve the physical and psychological symptoms of patients,
nursing is to control the progress of heart failure and relieve and improve their quality of life has become a nursing
clinical symptoms. Statistics show that about 10% [2] of problem in treatment of patients with advanced heart failure.
chronic heart failure patients in China have progressed to Semistructured interview means that only the basic structure
advanced heart failure and patients with advanced heart and process of the interview are set, and the interview can be
failure may have a progressive decline in cardiac functions, conducted in an easy and participatory way. It combines
so they often have persistent heart failure symptoms and open exploration and field focus to deeply explore the inner
2 Emergency Medicine International

thoughts and needs of patients. There have been studies that physical condition. The interview group constructed a
have applied it to the control survey on risk factors of high- palliative care regimen based on the semistructured inter-
risk groups with cardiovascular diseases and achieved good view from a doctor-patient perspective. Specifically, first, a
results [4]. Based on the perspective of medical personnel semistructured interview based on the doctor-patient per-
and patients, more scientific and effective nursing plans can spective. ①. A semistructured interview group was estab-
be formulated. Therefore, this study applied semistructured lished, and the group members consisted of 2 attending
interviews from the perspectives of medical staff and patients physicians in the department of cardiology, a head nurse, 3
in the formulation of a palliative care regimen for patients nurses in charge, and several nurses; a nurse was responsible
with advanced heart failure to observe the effect; the specific for literature retrieval from the literature and previous cases
results were now reported in the following contents. with keywords such as “advanced heart failure,” “patient
needs,” “semistructured interviews,” and “palliative care.”
The group held a discussion meeting and based on the search
2. Materials and Methods
results, an interview outline was drawn up. The interview
2.1. General Information. A total of 112 patients with ad- outline includes a “patient perspective” (Based on patients’
vanced heart failure who were admitted to the hospital from own experience, patients’ feelings about the disease can be
December 2019 to December 2021 were selected and divided understood.), based on patients’ energy, feelings, distress,
into an interview group (n � 56) and a routine group (n � 56) and understanding of palliative care, and a hospital per-
by the random number table method. Inclusion criteria were spective: from the perspective of the hospital (Based on
as follows: ① combined with the history and symptoms of patients’ views on the hospital and their needs, it can un-
patients’ primary disease, those diagnosed as heart failure by derstand the current shortcomings of the hospital and the
echocardiography and other examinations [5]; ② those with needs of the patients provided by the hospital, so as to
advanced heart failure; ③ those who fully understood the formulate an optimization regimen), the patients’ views on
content and purpose of the study, and voluntarily agreed to the treatment plan given by the medical staff at the current
participate in the research. Exclusion criteria were as follows: stage and the medical staff, their expectations for the medical
① those combined with serious diseases of other systems, staff, the demand for nursing care, and the most wanted help
such as decompensated liver cirrhosis; ② those with a in the face of the current condition and symptoms. After the
history of psychological/neurological/psychiatric disease; ③ outline was drawn up, 2 patients were selected for preventive
those with language/hearing impairment cannot be inter- interviews, and the time and place were agreed upon with the
viewed. Among them, there were 29 males and 27 females in patients. All members participating in the interviews learned
the interview group; the age ranged from 41 to 82 years old, the semistructured interview dialogue skills and procedures
with an average of (61.89 ± 14.37) years old; the average before the interviews began. Before the interview, the
monthly household income per capita was consent of the patients was obtained before the recording
(5213.48 ± 2596.31) yuan; 25 of them had long-term (more was made. A recording pen was used to record the whole
than 10 years)) smoking history; 17 cases have hypertension, process of the interview, and the nonverbal movements of
30 cases have coronary heart disease, and the remaining 9 the patients, such as tone particles, body movements, etc.,
cases have other underlying diseases; 31 cases were educated were also recorded with pens, and the corresponding in-
by high school or below (including vocational junior/senior terview questions and answers of the patients’ nonverbal
technical middle school), 25 cases have an educational movements were marked. After the prevention interview,
background of under graduation or above (including junior the focus of the interview was adjusted accordingly, and a
college). There were 30 males and 26 females in the routine formal interview was conducted. After the interview, the
group; the age ranged from 40 to 83 years old, with an recording file was processed, converted into a verbatim
average of (62.59 ± 15.13) years; the average monthly transcript, and the patients’ nonverbal actions were marked
household income per capita was (5396.72 ± 2608.33) yuan; in the corresponding position and saved as a word docu-
24 of them had long-term (more than 10 years) smoking ment. NVivo12 qualitative data analysis software was used
history; 18 cases have hypertension, 31 cases have coronary for data analysis. A nurse in charge and a nurse jointly
heart disease, and the remaining 7 cases have other un- completed the coding of transcribed texts, and the grounded
derlying diseases; 29 cases have accepted education level of theory was used for analysis and 3-level coding. Specifically,
high school and below (including vocational junior/senior the specific words and phenomena in the interview draft
technical middle school), and 27 cases have accepted un- were extracted, decomposed into concepts and thoughts,
dergraduate and above (including junior college) education. and renamed, and then classified, by thinking about the
There was no significant difference in the clinical data be- relationship between the categories to summarize the core
tween the two groups (P > 0.05). categories and keywords. Second, construction of palliative
care regimen: according to the interview results, the opti-
mization of the palliative care regimen was completed.
2.2. Methods. The routine group was given routine care for Specifically, medication compliance: after conducting a
heart failure, specifically giving medication and dietary grounded theoretical analysis of the interview and observing
guidance, orally explaining the precautions for advanced the responses of the respondents, it was found that when
heart failure, and giving monthly follow-up calls after the talking about the use of heart failure drugs, some patients
patient was discharged to care about the patients’ recent have symptoms of guilt and distress, such as frowning,
Emergency Medicine International 3

erratic eyes, and restlessness. These patients reported that in digestion should be selected. ③ Continued nursing care:
they failed to take heart failure drugs on time. In response to Some patients expressed concern and nervousness such as
this, ① for patients who failed to take their medicines on “sighing,” “sorrowful face,” “hands clenched,” and so on
time because of a complicated type of drugs and their own about the post-discharge nursing care during the interview.
memory decline, the nurse in charge of the bed would re- In response to this, a WeChat public account was estab-
mind and guide the patients to take medicines regularly lished, relevant knowledge should be published daily, and a
every day by contacting their family members or themselves WeChat group for patients with heart failure should be
with WeChat after discharge; For patients who lacked self- created. Patients and their families who have been admitted
management responsibility and stopped taking medication to our hospital should be included in the group, and the
without authorization after symptoms were relieved, med- WeChat group was used to answer questions for patients and
ical staff should provide health education in the form of provide patients with professional, reliable sources of in-
video + explanation, one-to-one face-to-face guidance, etc., formation. 4. Social support: Due to the limitation of daily
according to the cultural level of such patients, so as to help activities, some patients said that their social relationships
patients deeply understand the need for medication, regu- were difficult to be maintained, and the economic pressure
larly checked the patients’ medication, managing and su- brought by long-term treatment also made the patients feel
pervising the patients’ heart failure medication after guilty. In response to this, the exchange meeting for patients
discharge. ②. Symptom management: when talking about with advanced chronic heart failure was regularly held, and
heart failure feelings and physical symptoms, some patients the hospital sent a special car to pick up the heart failure
have symptoms of anxiety and depression such as “down- patients. At the meeting, patients exchanged their heart
ward corners of the mouth,” “sighing,” “frowning,” “per- failure treatment experience, shared their distress, conveyed
spiration,” and “drinking water frequently.” These patients happiness, and encouraged patients’ families to communi-
expressed symptoms of heart failure. The burden was sig- cate more and care about patients’ emotions.
nificant and has seriously affected the daily life of patients.
Aiming at this, ① for patients with sleep disorders, it should
eliminate adverse stimuli in the environment, such as 2.3. Assessment Indicators. The assessment indicators were
avoiding noisy sleeping environments to provide comfort- as follows: ① Mental state: The Depression-Anxiety-Stress
able beds and ensure the temperature of sleeping patients. Scale (DASS-21) was used for evaluation, which evaluated
Providing patients with mindfulness meditation and at- the patients’ mental status from three dimensions: depres-
tention transfer method to avoid focusing on their own sion (7 items), anxiety (7 items), and stress (7 items). Each
physical conditions before going to bed to avoid insomnia. item was recorded as 0–3 points and its score was positively
Establishing good sleep habits, turned off the lights before correlated with the negative degree of the patients’ mental
10: 30 every day, and prepared to fall asleep. Before going to state [6].② Symptoms: Memorial Symptom Assessment
bed, patients could soak feet in warm water to relieve fatigue. Scale-Heart Failure (MSAS-HF) was used to assess the se-
② For patients with dyspnea, we instructed them to carry verity of the patients’ symptoms. The scale evaluated the
out breathing training, blowing 5 balloons each time, 3 times severity of the patients’ symptoms from the patients’
a day, and daily practice breathing with the lips half closed. physical symptoms (21 items), psychological symptoms (6
③ For patients with limb edema, we instructed patients and items), and heart failure symptoms (5 items). Each item has a
their families to check their body weight and leg circum- score of 1–4, and its score was positively correlated with the
ference every day and gave appropriate massage to promote severity of the patients’ symptoms [7]. ③ Quality of life: the
limb circulation. Strenuous exercise should not be per- Kansas City Cardiomyopathy Questionnaire (KCCQ) was
formed for patients with advanced heart failure. At this time, used to assess the quality of life, which included physical
the patients’ family should be instructed to assist the patients limitations (5 items), symptoms (6 items), heart failure
in exercising in bed, such as elevating the lower body. ④ For cognition (4 items), social dysfunction (5 items), and quality
patients with symptoms of fatigue, we analyzed the cause of of life (3 items), from the 5 aspects to evaluate the quality of
the patients’ fatigue, and the intervention methods for sleep life of patients, and its score was positively correlated with
disorders were the same as above. For patients with psy- the quality of life of patients [8]. The changes of DASS-21,
chological fatigue, we should analyze the reasons. Some MSAS-HF, and KCCQ scores in the two groups before and
patients showed depression when referring to the prognosis after intervention were compared, and the differences in the
of the disease. Nurses should give them examples of cases of readmission rate and mortality between the two groups were
successful stabilization after intervention and treatment, compared.
through data analysis to show patients with advanced heart
failure that through systematic intervention and treatment,
the five-year survival rate was relatively high, helping pa- 2.4. Statistical Analysis. The data collected in this study were
tients to build treatment confidence and avoid excessive analyzed by using SPSS24.0. The measurement data were
worry. For patients with malnutrition and fatigue, a nu- presented in the form of (x ± s), and the comparison was
tritious recipe should be formulated. The recipe should meet performed by using t-test; the count data were presented in
the patients’ personal preferences while meeting the dietary the form of (n (%)), and the chi-square test was used. When
requirements of advanced heart failure. Excessive greasy P < 0.05, the difference between groups was statistically
food should be avoided and foods that are easy to eat and aid significant.
4 Emergency Medicine International

Table 1: Comparison of the psychological status between the two groups before and after intervention (x ± s, points).
Depression Anxiety Pressure
Group N
Before intervention After intervention Before intervention After intervention Before intervention After intervention
Interview 56 13.24 ± 3.32 9.25 ± 2.27∗ 15.24 ± 3.71 12.95 ± 3.09∗ 16.24 ± 3.11 12.78 ± 4.07∗
Routine 56 12.97 ± 3.19 12.05 ± 2.76 14.95 ± 3.62 14.51 ± 2.91 16.08 ± 3.25 15.39 ± 3.84
t — 0.439 5.863 0.419 2.750 0.266 3.491
P — 0.662 <0.001 0.676 0.007 0.791 0.001
∗
Note. Compared with before intervention, P < 0.05.

Table 2: Comparison of symptoms before and after intervention in the two groups (x ± s, points).
Physical symptoms Psychological symptoms Heart failure symptoms
Group n
Before intervention After intervention Before intervention After intervention Before intervention After intervention
Interview 56 59.87 ± 12.25 49.45 ± 10.37∗ 17.26 ± 4.91 13.17 ± 3.85∗ 14.52 ± 2.81 12.27 ± 2.94∗
Routine 56 61.38 ± 11.96 57.46 ± 13.84 16.87 ± 4.55 15.92 ± 4.30 14.03 ± 2.69 13.64 ± 2.58
t 0.660 3.466 0.436 3.566 0.943 2.621
P 0.511 0.001 0.664 0.001 0.348 0.010
∗
Note.Compared with before intervention, P < 0.05.

3. Results patients, leading to the emergence of negative emotions such

as anxiety and depression, and the dual psychological and
3.1. Comparison of the Psychological State. After 1 month of physical pressures can seriously affect the quality of daily life
intervention, the scores of DASS-21 in the interview group of patients [9]. The results of this study showed that after
were significantly decreased (P < 0.05), and the interview intervention, the decrease rate of DASS-21, MSAS-HF and
group was significantly lower than the routine group at the the increase rate of KCCQ in the interview group were
same time (P < 0.05) as shown in Table 1. significantly higher than those in the routine group. This
indicates that semistructured interviews based on a doctor-
3.2. Symptom Comparison. After 1 month of intervention, patient perspective can alleviate the symptoms of patients
the MSAS-HF scores of each dimension in the interview with advanced heart failure and improve their psychological
group were significantly decreased (P < 0.05), and the in- state and quality of life. The reasons are as follows. ① It
terview group was significantly lower than that in the routine showed that the semi-structured interview based on the
group at the same time (P < 0.05) as shown in Table 2. perspective of doctors and patients was through semi-
structured interviews on patients by setting the interview
outline from the patients’ own experience and disease
3.3. Comparison of the Quality of Life. After 1 month of cognition and patients’ cognition, needs, and expectations
intervention, the KCCQ scores in the interview group were toward the hospital in the early stage to fully understand the
significantly increased (P < 0.05), and the interview group needs of patients so as to formulate targeted palliative care
was significantly higher than the routine group at the same regimen based on the actual needs of patients [10]. ②
time (P < 0.05) as shown in Table 3. Through semistructured interviews, it only draw up inter-
view outlines by reviewing documents and medical records
3.4. Comparison of the Prognosis between the Two Groups. in the early stage, without strict requirements for interview
Within 1 month of intervention, the rehospitalization rate in procedures. The interview has a more relaxed atmosphere
the interview group was significantly lower than that in the than structured interviews. The rhythm and sequence could
routine group (P < 0.05), and there was no significant dif- be controlled by the interviewer, but it was more rigorous
ference in mortality between the two groups (P > 0.05) as than unstructured interviews. It could set the general tone of
shown in Table 4. the interview, prevent background deviation, guide patients
to express their true thoughts, and record the results of the
4. Discussion interview through text/recording. Quantitative analysis of
interview results were done at a later stage to clarify patient
Advanced heart failure can cause cardiac structural recon- needs, so as to provide patients with high-quality care and
struction and abnormal cardiac function due to long-term help patients with symptom management [11]. ③ Semi-
myocardial damage, so patients may have a variety of clinical structured interviews based on the doctor-patient perspec-
symptoms. Previous studies have shown that more than half tive, through the interview results, a palliative care regimen
of heart failure patients can experience 15 symptoms such as in terms of individualized medication compliance, multi-
sleep disturbance, depression, anxiety, and fatigue [2]. Re- symptom management, and continuous nursing was con-
curring somatic symptoms, economic pressure brought by structed. Therefore, a palliative care regimen was more
long-term treatment, and social and daily life barriers caused targeted and could effectively control the clinical symptoms
by somatic symptoms can all cause psychological burdens on of patients. ④ A palliative care regimen based on
 Emergency Medicine International

Table 3: Comparison of the quality of life before and after intervention between the two groups (x ± s, points).
Physical limitation Symptom Heart failure cognition Social dysfunction Quality of life
Group n Before After Before Before After Before After After Before After
intervention intervention intervention intervention intervention intervention intervention intervention intervention intervention
Interview 56 13.45 ± 2.81 15.43 ± 3.20∗ 14.86 ± 3.10 13.61 ± 3.30 17.54 ± 4.22∗ 8.41 ± 2.17 10.12 ± 3.04∗ 18.62 ± 4.88∗ 11.29 ± 2.53 14.89 ± 3.12∗
Routine 56 12.96 ± 3.01 13.29 ± 3.12 15.42 ± 3.28 13.29 ± 3.25 13.48 ± 3.57 8.15 ± 2.09 8.61 ± 2.47 16.37 ± 3.59 10.87 ± 2.64 11.35 ± 2.78
t 0.890 3.583 0.929 0.517 5.497 0.646 2.885 2.779 0.943 6.339
P 0.375 0.001 0.355 0.606 <0.001 0.520 0.005 0.006 0.348 <0.001
∗
Note. Compared with before intervention, P < 0.05.
5
6 Emergency Medicine International

Table 4: Comparison of the prognosis of the two groups of patients Conflicts of Interest
(n (%)).
The authors declare that the research was conducted in the
Group n Rehospitalization Mortality
absence of any commercial or financial relationships that
Interview 56 1 (1.79) 0 (0.00)
could be construed as a potential conflict of interest.
Routine 56 7 (12.50) 0 (0.00)
χ2 — 4.486 0.000
P — 0.028 1.000 References
[1] K. Ni, K. Wang, and B. Deng, “Research progress of traditional
semistructured interviews from a doctor-patient perspective Chinese medicine in the treatment of heart failure with
could increase the enthusiasm of patients for treatment and preserved ejection fraction,” Shaanxi Traditional Chinese
help patients to establish social relationships through pos- Medicine, vol. 43, no. 3, pp. 405–408, 2022.
itive case support, data analysis, provide a platform for [2] Y. T. Xu, Y. C. Luo, J.-H. Xue et al., “Micropyrones A and B,
patients with advanced heart failure to chat, encourage two new α-pyrones from the actinomycete Microbacterium
patients’ family members to accompany them to increase sp. GJ312 isolated from Glycyrrhiza uralensis Fisch,” Natural
patients’ enthusiasm for treatment, help patients to establish Product Research, vol. 29, no. 8, pp. 1–6, 2021.
[3] X. N. Zhou, Z. Li, and X. F. Kang, “Concept evolution and clinical
social relationships, and improve patients’ social support to
significance of palliative care in patients with heart failure,”
improve their psychological state and improve their quality Medicine and Philosophy (B), vol. 38, no. 9, pp. 51–54, 2017.
of life. [4] K. Tanaka, M. Kabayama, K. Sugimoto et al., “SONIC study
Previous studies have shown that advanced heart failure is group. Association between uric acid and atherosclerosis in
associated with higher rehospitalization and mortality due to community-dwelling older people: The SONIC study,” Geriatrics
its uncontrollable symptoms and persistent cardiac function & Gerontology International, vol. 21, no. 1, pp. 94–101, 2021.
decline [12]. The results of this study showed that the [5] W. Liu and R. Wei, “Diagnosis and treatment strategies of
rehospitalization rate of the interview group was lower than heart failure with preserved ejection fraction,” Chinese Gen-
that of the routine group and the difference was significant. eral Medicine, vol. 24, no. 3, pp. 253–258, 2021.
The reason for this is that Zhao et al. [13] have shown that low [6] S. Mani, S. Sharma, B. Omar, A. Paungmali, and L. Joseph,
“Validity and reliability of Internet-based physiotherapy assess-
medication compliance, poor diet control, and the lack of
ment for musculoskeletal disorders: a systematic review,” Journal of
professional guidance and information sources after dis- Telemedicine and Telecare, vol. 23, no. 3, pp. 379–391, 2017.
charge lead to a decline in nursing quality are all risk factors [7] F. Wang and J. Zhang, “Research progress on symptom cluster
for rehospitalization for advanced heart failure. The semi- assessment tools for patients with chronic heart failure,”
structured interview from the perspective of doctor and Journal of Nursing, vol. 23, no. 22, pp. 28–32, 2016.
patient was through the results of the previous interview, in [8] Y. Peng, X. Wu, S. Atkins et al., “Internet-based health ed-
the construction of the follow-up palliative care regimen, ucation in China: a content analysis of websites,” BMC
corresponding nursing care was given according to the Medical Education, vol. 27, no. 10, pp. 14–16, 2014.
reasons for the patients’ not taking medicines on time, and a [9] C. Zhang, H. J. Yang, and L. L. Dong, “A qualitative study on
diet plan was formulated for the patients. It provided con- palliative care needs of patients with advanced heart failure
tinuous nursing care for discharged patients through WeChat from the perspective of doctors and patients,” Journal of
Nursing, vol. 37, no. 2, pp. 12–14, 2022.
groups and WeChat official accounts and provided patients
[10] K. E. Sanchack and C. A. Thomas, “Autism spectrum disorder:
with professional, reliable, and stable information sources primary care principles,” American Family Physician, vol. 94,
outside the hospital, so as to ensure the quality of patient’ care no. 12, pp. 972–979, 2016.
outside the hospital and reduce the incidence of readmission [11] L. Xu and Q. Wang, “A study on the dilemma and formation
[14]. The results of this study also found that there were no mechanism of the elderly persons with intellectual disabilities
deaths in the two groups during the intervention period, and their guardians from the perspective of feasible ability: an
which may be related to the short follow-up time in this study. analysis based on case interviews in Xi’an,” Journal of
However, this study still has the following two defi- Northwest University, vol. 52, no. 1, pp. 146–160, 2022.
ciencies: (1) the study sample size was small and (2) the [12] J. B. Wang and C. Ling, “Predictive value of peripheral blood
follow-up time was short, and there were no deaths during glucose-like antigen 125 and N-terminal brain natriuretic
peptide precursor levels on readmission rate in patients with
the follow-up period. In the future, the sample size should be
chronic heart failure,” Chinese Journal of Physician Ad-
expanded and the follow-up time should be extended in vancement, vol. 43, no. 10, pp. 892–895, 2020.
further research. [13] C. Zhao, W. Geng, and X. Tian, “Analysis of risk factors for
In conclusion, a palliative care regimen based on sem- rehospitalization in patients with heart failure within 6
istructured interviews from a doctor-patient perspective can months,” Medical Review, vol. 24, no. 11, pp. 2275–2280, 2018.
improve the psychological state of patients with advanced [14] M. S. Joseph, M. Palardy, and N. M. Bhave, “Management of
heart failure, control clinical symptoms, improve their heart failure in patients with end-stage kidney disease on
quality of life, and prevent readmission. maintenance dialysis: a practical guide,” Reviews in Cardio-
vascular Medicine, vol. 21, no. 1, pp. 31–39, 2020.
Data Availability
The data can be obtained from the author upon reasonable
request.