Examining Adherence and Dose Effect of an Early Palliative Care Intervention for Advanced Heart Failure Patients

Rachel Wells; James Nicholas Dionne-Odom; Andres Azuero; Harleah Buck; Deborah Ejem; Kathryn L Burgio; Macy L Stockdill; Rodney Tucker; Salpy V Pamboukian; Jose Tallaj; Sally Engler; Konda Keebler; Sheri Tims; Raegan Durant; Keith M Swetz; Marie Bakitas

doi:10.1016/j.jpainsymman.2021.01.136

Examining Adherence and Dose Effect of an Early Palliative Care Intervention for Advanced Heart Failure Patients

J Pain Symptom Manage. 2021 Sep;62(3):471-481. doi: 10.1016/j.jpainsymman.2021.01.136. Epub 2021 Feb 5.

Authors

Affiliations

¹ School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA. Electronic address: raduncan@uab.edu.
² School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Medicine, Division of Gerontology, Geriatrics, Palliative Care, UAB Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, AL, USA.
³ School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA.
⁴ Csomay Center for Gerontological Excellence, College of Nursing, University of Iowa Iowa City, IA, USA.
⁵ Department of Medicine, Division of Gerontology, Geriatrics, Palliative Care, UAB Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, AL, USA; Birmingham VA Medical Center, Birmingham, AL, USA.
⁶ Department of Medicine, Division of Gerontology, Geriatrics, Palliative Care, UAB Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, AL, USA.
⁷ Department of Medicine, Division of Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham, AL, USA.
⁸ Department of Medicine, Division of Preventative Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.

Abstract

Context: Research priority guidelines highlight the need for examining the "dose" components of palliative care (PC) interventions, such as intervention adherence and completion rates, that contribute to optimal outcomes.

Objectives: Examine the "dose" effect of PC intervention completion vs. noncompletion on quality of life (QoL) and healthcare use in patients with advanced heart failure (HF) over 32 weeks.

Methods: Secondary analysis of the ENABLE CHF-PC intervention trial for patients with New York Heart Association (NYHA) Class III/IV HF. "Completers" defined as completing a single, in-person outpatient palliative care consultation (OPCC) plus 6 weekly, PC nurse coach-led telehealth sessions. "Non-completers" were defined as either not attending the OPCC or completing <6 telehealth sessions. Outcome variables were QoL and healthcare resource use (hospital days; emergency department visits). Mixed models were used to model dose effects for "completers" vs "noncompleters" over 32 weeks.

Results: Of 208 intervention group participants, 81 (38.9%) were classified as "completers" with a mean age of 64.6 years; 72.8% were urban-dwelling; 92.5% had NYHA Class III HF. 'Completers' vs. "non-completers"" groups were well-balanced at baseline; however "noncompleters" did report higher anxiety (6.0 vs 7.0, P < 0.05, d = 0.28). Moderate, clinically significant, improved QoL differences were found at 16 weeks in "completers" vs. "non-completers" (between-group difference: -9.71 (3.18), d = 0.47, P = 0.002) but not healthcare use.

Conclusion: Higher intervention completion rates of an early PC intervention was associated with QoL improvements in patients with advanced HF. Future work should focus on identifying the most efficacious "dose" of intervention components and increasing adherence to them.

Trial registration: ClinicalTrials.gov Identifier: NCT02505425.

Keywords: Palliative care; heart failure; intervention dose effect.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Heart Failure* / therapy
Hospice and Palliative Care Nursing*
Humans
Middle Aged
Palliative Care
Quality of Life
Telemedicine*

Associated data

ClinicalTrials.gov/NCT02505425

Abstract

Publication types

MeSH terms

Associated data

Grants and funding