Rachel Wells1, James Nicholas Dionne-Odom2, Andres Azuero3, Harleah Buck4, Deborah Ejem3, Kathryn L Burgio5, Macy L Stockdill3, Rodney Tucker6, Salpy V Pamboukian7, Jose Tallaj7, Sally Engler3, Konda Keebler3, Sheri Tims3, Raegan Durant8, Keith M Swetz6, Marie Bakitas2. 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.
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.
Authors: Anita A Kelkar; John Spertus; Peter Pang; Renee F Pierson; Robert J Cody; Ileana L Pina; Adrian Hernandez; Javed Butler Journal: JACC Heart Fail Date: 2016-02-10 Impact factor: 12.035
Authors: Pauline M Kane; Barbara A Daveson; Karen Ryan; Clare I Ellis-Smith; Niall G Mahon; Brendan McAdam; Regina McQuilllan; Cecelia Tracey; Christine Howley; Geraldine O'Gara; Caroline Raleigh; Irene J Higginson; Jonathan Koffman; Fliss E M Murtagh Journal: BMJ Support Palliat Care Date: 2017-09-01 Impact factor: 3.568
Authors: Kathryn S Hayward; Leonid Churilov; Emily J Dalton; Amy Brodtmann; Bruce C V Campbell; David Copland; Numa Dancause; Erin Godecke; Tammy C Hoffmann; Natasha A Lannin; Matthew W McDonald; Dale Corbett; Julie Bernhardt Journal: Stroke Date: 2021-01-12 Impact factor: 7.914
Authors: Rachel Wells; Macy L Stockdill; J Nicholas Dionne-Odom; Deborah Ejem; Kathryn L Burgio; Raegan W Durant; Sally Engler; Andres Azuero; Salpy V Pamboukian; Jose Tallaj; Keith M Swetz; Elizabeth Kvale; Rodney O Tucker; Marie Bakitas Journal: Trials Date: 2018-08-06 Impact factor: 2.279
Authors: J Nicholas Dionne-Odom; Deborah B Ejem; Rachel Wells; Andres Azuero; Macy L Stockdill; Konda Keebler; Elizabeth Sockwell; Sheri Tims; Sally Engler; Elizabeth Kvale; Raegan W Durant; Rodney O Tucker; Kathryn L Burgio; Jose Tallaj; Salpy V Pamboukian; Keith M Swetz; Marie A Bakitas Journal: JAMA Netw Open Date: 2020-04-01
Authors: Mary Pilar Ingle; Devon Check; Daniel Hogan Slack; Sarah H Cross; Natalie C Ernecoff; Daniel D Matlock; Dio Kavalieratos Journal: J Pain Symptom Manage Date: 2021-10-29 Impact factor: 3.612
Authors: Natalie C Ernecoff; Andrew Bilderback; Johanna Bellon; Robert M Arnold; Michael Boninger; Dio Kavalieratos Journal: J Palliat Med Date: 2021-03-23 Impact factor: 2.947