Focused Palliative Care Intervention in Advanced Heart Failure
| Status: | Active, not recruiting |
|---|---|
| Conditions: | Cardiology |
| Therapuetic Areas: | Cardiology / Vascular Diseases |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 7/20/2016 |
| Start Date: | September 2014 |
| End Date: | December 2016 |
Pilot Study of a Focused Palliative Care Intervention for Recently Hospitalized High-Risk Patients With Heart Failure
This small pilot study will be assessing the the impact of a standardized, social-worker
led, longitudinal palliative care intervention on alignment of patient and physician
understanding of prognosis and goals of care. Secondary objectives include assessing the
impact of this intervention on documentation of advanced care planning and end of life
preferences, symptom burden, quality of life and health care utilization.
led, longitudinal palliative care intervention on alignment of patient and physician
understanding of prognosis and goals of care. Secondary objectives include assessing the
impact of this intervention on documentation of advanced care planning and end of life
preferences, symptom burden, quality of life and health care utilization.
Patients will be assigned to one of two groups a) longitudinal goals of care discussion led
by a palliative care-trained social worker or b) usual care + written information regarding
advanced directives. The intervention group will be enrolled in the hospital and then be
followed longitudinally for 3 months by a palliative care-trained social worker who will
shepherd a conversation around prognosis, expectations, and goals of care. The results of
these conversations will be documented in the electronic medical record and shared with the
clinical team. Clinical symptoms that are identified during these conversations will be
evaluated by a Palliative Care Physician who will relay suggestions regarding management to
the primary treating clinician. Baseline surveys will assess prognostic awareness, symptom
burden, anxiety, depression, and quality of life for both groups. At the conclusion of the
study, an individualized follow-up plan will be devised for each patient based on a needs
assessment by the study social worker.
Patients assigned to the control/usual care arm will complete the same series of
questionnaires as those assigned to the intervention group and will undergo usual in
hospital and post-discharge treatment as directed by their care team. All control subjects
will receive written Advanced Care planning and Heart Failure education materials as
provided routinely to inpatients at Brigham and Women's Hospital. At the three month visit
(Final Visit) following hospitalization, these patients will be asked to complete follow up
questionnaires and then will be given the option to participate in the above verbal
intervention and guided "Goals and Values" conversation that was provided to the
intervention group.
by a palliative care-trained social worker or b) usual care + written information regarding
advanced directives. The intervention group will be enrolled in the hospital and then be
followed longitudinally for 3 months by a palliative care-trained social worker who will
shepherd a conversation around prognosis, expectations, and goals of care. The results of
these conversations will be documented in the electronic medical record and shared with the
clinical team. Clinical symptoms that are identified during these conversations will be
evaluated by a Palliative Care Physician who will relay suggestions regarding management to
the primary treating clinician. Baseline surveys will assess prognostic awareness, symptom
burden, anxiety, depression, and quality of life for both groups. At the conclusion of the
study, an individualized follow-up plan will be devised for each patient based on a needs
assessment by the study social worker.
Patients assigned to the control/usual care arm will complete the same series of
questionnaires as those assigned to the intervention group and will undergo usual in
hospital and post-discharge treatment as directed by their care team. All control subjects
will receive written Advanced Care planning and Heart Failure education materials as
provided routinely to inpatients at Brigham and Women's Hospital. At the three month visit
(Final Visit) following hospitalization, these patients will be asked to complete follow up
questionnaires and then will be given the option to participate in the above verbal
intervention and guided "Goals and Values" conversation that was provided to the
intervention group.
Inclusion Criteria
- Symptomatic Heart Failure (NYHA II-IV)
- Hospitalized or recently for acute decompensation with at least one of the following
high-risk features
- Prior hospitalization for Heart Failure (HF) within 1 year
- Age > 80 years
- Chronic Kidney Disease (estimated Glomerular Filtration Rate (eGFR) < 45
mL/min/m2)
- Systolic Blood Pressure < 100 mm Hg
- Serum sodium < 130 meq/L
- Cardiogenic Shock (Cardiac Index < 2.0)
- Serious Non-Cardiovascular Illness (e.g. advanced stage cancer, Chronic
Obstructive Pulmonary Disease (COPD) , or the like.
- Ability to Provide Informed Consent
- Permission of attending physician
Exclusion Criteria
- Anticipated major cardiac surgery, including Ventricular Assist Device (VAD) or
transplant, within 3 months of enrollment
- Already enrolled in hospice or receiving outpatient palliative care
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