PMID- 33556493 OWN - NLM STAT- MEDLINE DCOM- 20211013 LR - 20220902 IS - 1873-6513 (Electronic) IS - 0885-3924 (Print) IS - 0885-3924 (Linking) VI - 62 IP - 3 DP - 2021 Sep TI - Examining Adherence and Dose Effect of an Early Palliative Care Intervention for Advanced Heart Failure Patients. PG - 471-481 LID - S0885-3924(21)00160-3 [pii] LID - 10.1016/j.jpainsymman.2021.01.136 [doi] AB - 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. CI - Copyright (c) 2021 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved. FAU - Wells, Rachel AU - Wells R AD - School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA. Electronic address: raduncan@uab.edu. FAU - Dionne-Odom, James Nicholas AU - Dionne-Odom JN AD - 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. FAU - Azuero, Andres AU - Azuero A AD - School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA. FAU - Buck, Harleah AU - Buck H AD - Csomay Center for Gerontological Excellence, College of Nursing, University of Iowa Iowa City, IA, USA. FAU - Ejem, Deborah AU - Ejem D AD - School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA. FAU - Burgio, Kathryn L AU - Burgio KL AD - 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. FAU - Stockdill, Macy L AU - Stockdill ML AD - School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA. FAU - Tucker, Rodney AU - Tucker R AD - Department of Medicine, Division of Gerontology, Geriatrics, Palliative Care, UAB Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, AL, USA. FAU - Pamboukian, Salpy V AU - Pamboukian SV AD - Department of Medicine, Division of Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham, AL, USA. FAU - Tallaj, Jose AU - Tallaj J AD - Department of Medicine, Division of Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham, AL, USA. FAU - Engler, Sally AU - Engler S AD - School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA. FAU - Keebler, Konda AU - Keebler K AD - School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA. FAU - Tims, Sheri AU - Tims S AD - School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA. FAU - Durant, Raegan AU - Durant R AD - Department of Medicine, Division of Preventative Medicine, University of Alabama at Birmingham, Birmingham, AL, USA. FAU - Swetz, Keith M AU - Swetz KM AD - Department of Medicine, Division of Gerontology, Geriatrics, Palliative Care, UAB Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, AL, USA. FAU - Bakitas, Marie AU - Bakitas M AD - 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. LA - eng SI - ClinicalTrials.gov/NCT02505425 GR - TL1 TR003106/TR/NCATS NIH HHS/United States GR - K99 NR019854/NR/NINR NIH HHS/United States GR - T32 HS013852/HS/AHRQ HHS/United States GR - F31 NR018782/NR/NINR NIH HHS/United States GR - R01 NR013665/NR/NINR NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20210205 PL - United States TA - J Pain Symptom Manage JT - Journal of pain and symptom management JID - 8605836 SB - IM MH - *Heart Failure/therapy MH - *Hospice and Palliative Care Nursing MH - Humans MH - Middle Aged MH - Palliative Care MH - Quality of Life MH - *Telemedicine PMC - PMC8339177 MID - NIHMS1670714 OTO - NOTNLM OT - Palliative care OT - heart failure OT - intervention dose effect EDAT- 2021/02/09 06:00 MHDA- 2021/10/14 06:00 PMCR- 2022/09/01 CRDT- 2021/02/08 20:12 PHST- 2020/10/01 00:00 [received] PHST- 2021/01/28 00:00 [revised] PHST- 2021/01/30 00:00 [accepted] PHST- 2021/02/09 06:00 [pubmed] PHST- 2021/10/14 06:00 [medline] PHST- 2021/02/08 20:12 [entrez] PHST- 2022/09/01 00:00 [pmc-release] AID - S0885-3924(21)00160-3 [pii] AID - 10.1016/j.jpainsymman.2021.01.136 [doi] PST - ppublish SO - J Pain Symptom Manage. 2021 Sep;62(3):471-481. doi: 10.1016/j.jpainsymman.2021.01.136. Epub 2021 Feb 5.