ENABLE CHF-PC: QOL Not Improved With Early Palliative Care Telehealth Intervention
A 16-week palliative care telehealth intervention for patients with advanced heart failure (HF) did not improve quality of life or mood, but did improve pain intensity and interference, according to a study published July 27 in JAMA Internal Medicine.
ENABLE CHF-PC was a culturally based, early palliative care intervention to address the gaps in reaching rural, minority and underserved patients with the lowest access to palliative care services. Quality of life and mood were the primary outcomes of this single-blind, nurse-led psychoeducational intervention. Secondary outcomes were pain, global health and resource use.
Of the 415 participants with ACC stage C or D heart failure, 54.5% were African American, 26% lived in a rural area and 45.8% had a high-school education or less. A total of 208 participants were randomized to receive an in-person palliative care consultation, six weekly nurse-coach telephonic sessions and monthly follow-up for 48 weeks, and 207 participants were randomized to receive usual care.
Marie A. Bakitas, DNSc, NP-C, et al., reported that the early palliative care intervention did not demonstrate improved quality of life or mood in an advanced HF population that was majority African American and had baseline good quality of life. The mean Kansas City Cardiomyopathy Questionnaire (KCCQ) score at baseline was 52.6, and this score improved by 3.9 points in the intervention group and 2.3 points in the usual care group at week 16. Pain intensity and pain interference in daily life did demonstrate a clinically important improvement. Global health and resource use were not different between the groups.
"[This] trial raises a key question about the likely influence of baseline QOL as a key element in determining which populations might show the greatest benefit from the scarce palliative care specialty resource," write the authors. "Future analyses and studies will examine both the patient factors and intervention components to find the right palliative care dose, for the right patients, at the right time."
Keywords: Palliative Care, Quality of Life, Global Health, Vulnerable Populations, African Americans, Single-Blind Method, Follow-Up Studies, Kansas, Telemedicine, Hospice and Palliative Care Nursing, Heart Failure, Pain, Referral and Consultation, Cardiomyopathies
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