|
1
|
Wells R, Stockdill ML, Dionne-Odom JN, Ejem D, Burgio KL, Durant RW, Engler S, Azuero A, Pamboukian SV, Tallaj J, Swetz KM, Kvale E, Tucker RO, Bakitas M. Educate, Nurture, Advise, Before Life Ends Comprehensive Heartcare for Patients and Caregivers (ENABLE CHF-PC): study protocol for a randomized controlled trial. Trials 2018; 19:422. [PMID: 30081933 PMCID: PMC6090835 DOI: 10.1186/s13063-018-2770-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 06/28/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Palliative care is specialized medical care for people with serious illness that is focused on providing relief from symptoms and stress and improving the quality of life (QOL) for patients and their families. To help the 6.5 million U.S. adults and families affected by heart failure manage the high symptom burden, complex decision-making, and risk of exacerbation and death, the early integration of palliative care is critical and has been recommended by numerous professional organizations. However, few trials have tested early outpatient community-based models of palliative care for patients diagnosed with advanced heart failure and their caregivers. To address this gap, through a series of formative evaluation trials, we translated an oncology early palliative care telehealth intervention for heart failure to create ENABLE CHF-PC (Educate, Nurture, Advise, Before Life Ends, Comprehensive Heartcare for Patients and Caregivers). METHODS/DESIGN The primary objective of this multisite pragmatic randomized controlled trial is to test the efficacy of ENABLE CHF-PC plus usual heart failure care compared to usual care alone. Community-dwelling persons who are ≥50 years of age with New York Heart Association class III/IV or American Heart Association/American College of Cardiology stage C/D heart failure and their primary caregiver (if present) are being randomized to one of two study arms. The ENABLE CHF-PC intervention group receives usual heart failure care plus an in-person palliative care assessment by a board-certified palliative care provider (caregivers are invited to attend), a series of nurse coach-led, weekly psychoeducational 20 to 60 min phone sessions using a guidebook called Charting Your Course (patients: 6 sessions and caregivers: 4 sessions), and monthly check-in calls. Charting Your Course topical content includes problem-solving, coping, self-care and symptom management, communication, decision-making, advance care planning, and life review (patients only). Primary outcomes include patient QOL and mood (depressive symptoms/anxiety) and caregiver QOL, mood, and burden at 8 and 16 weeks after baseline. Outcomes will be examined using an intention-to-treat approach and mixed effects modeling for repeated measures. DISCUSSION This trial will determine whether the ENABLE CHF-PC model of concurrent heart failure palliative care is superior to usual heart failure care alone in achieving higher patient and caregiver QOL, improving mood, and lowering burden. TRIAL REGISTRATION ClinicalTrials.gov, NCT02505425 . Registered on 22 July 2015.
Collapse
Affiliation(s)
- Rachel Wells
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-1210 USA
| | - Macy L. Stockdill
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-1210 USA
| | - J. Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-1210 USA
| | - Deborah Ejem
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-1210 USA
| | - Kathryn L. Burgio
- Department of Medicine, Division of Gerontology, Geriatrics, Palliative Care, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-1210 USA
- Birmingham VA Medical Center, VAMC 11G, 700 19th St South, Birmingham, AL 35233-0001 USA
| | - Raegan W. Durant
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-1210 USA
| | - Sally Engler
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-1210 USA
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-1210 USA
| | - Salpy V. Pamboukian
- Department of Medicine, Division of Cardiovascular Diseases, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-1210 USA
| | - Jose Tallaj
- Department of Medicine, Division of Cardiovascular Diseases, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-1210 USA
| | - Keith M. Swetz
- Department of Medicine, Division of Gerontology, Geriatrics, Palliative Care, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-1210 USA
| | - Elizabeth Kvale
- Department of Medicine, Dell Medical School, University of Texas at Austin, 1501 Red River Street, Austin, TX 78712 USA
| | - Rodney O. Tucker
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-2041 USA
| | - Marie Bakitas
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-1210 USA
- Department of Medicine, Division of Gerontology, Geriatrics, Palliative Care, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-1210 USA
| |
Collapse
|