Clinician Insights into Effective Components, Delivery Characteristics and Implementation Strategies of Ambulatory Palliative Care for People with Heart Failure: A Qualitative Analysis

•In this qualitative descriptive study, specialist palliative care (SPC) and cardiology clinicians across 7 Department of Veterans Affairs medical centers with established ambulatory palliative care clinics identified necessary components and delivery characteristics of ambulatory SPC for people with heart failure and strategies for implementation.•Discussion of goals of care and connecting patients/caregivers to resources were essential components of ambulatory SPC that were provided at participating facilities. Clinicians preferred integrated approaches to SPC delivery, employed standardized patient selection and referral procedures, and formalized procedures for handoffs to and from SPC.•Necessary strategies to address barriers to ambulatory SPC implementation included deploying palliative champions, educating non-SPC clinicians about the value of ambulatory SPC for people with heart failure, and developing ambulatory models through leadership support.•Prioritizing these mutually valued and necessary features of ambulatory SPC delivery may facilitate the adoption of ambulatory SPC more broadly across care settings and health care systems. To elicit perspectives from specialist palliative care (SPC) and cardiology clinicians concerning the necessary components, delivery characteristics and implementation strategies of successful ambulatory SPC for people with heart failure (HF). Palliative care is a recommended component of guideline-directed care for people with HF. However, optimal strategies to implement SPC within ambulatory settings are unknown. We conducted a qualitative descriptive study composed of semistructured interviews with SPC and cardiology clinicians at Veterans Affairs Medical Centers (VAMCs) with the highest number of ambulatory SPC consultations within the VA system among people with HF between 2021 and 2022. Clinicians were asked how they provided ambulatory SPC and what they felt were the necessary components, delivery characteristics and implementation strategies of care delivery. Interviews were analyzed using directed content analysis. We interviewed 14 SPC clinicians and 9 cardiology clinicians at 7 national VAMCs; 43% were physicians, and 48% were advanced-practice registered nurses/physician associates. Essential components of ambulatory SPC encompassed discussion of goals of care (eg, prognosis, advance directives) and connecting patients/caregivers to resources (eg, home care). Preferred delivery characteristics included inte