A Study to Improve Communication Between Clinicians and Patients With Advanced Heart Failure: Methods and Challenges Behind the Working to Improve Discussions About Defibrillator Management Trial

Goldstein, Nathan E.; Kalman, Jill; Kutner, Jean S.; Fromme, Erik K.; Hutchinson, Mathew D.; Lipman, Hannah I.; Matlock, Daniel D.; Swetz, Keith M.; Lampert, Rachel; Herasme, Omarys

doi:10.1016/j.jpainsymman.2014.03.005

Cited by 28 publications

(9 citation statements)

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“…While previous studies have examined the symptom experience from an HF perspective (8,10) and reported interventions to address palliative care communication gaps (14,29,30), a persistent gap has been the lack of randomized, controlled trials demonstrating the effectiveness of interventions that target the intersection of advanced HF and palliative care.…”

Section: Discussionmentioning

confidence: 99%

Palliative Care in Heart Failure

Rogers

Patel

Mentz

et al. 2017

Journal of the American College of Cardiology

455

110

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BACKGROUND Advanced heart failure (HF) is characterized by high morbidity and mortality. Conventional therapy may not sufficiently reduce patient suffering and maximize quality of life. OBJECTIVES . We investigated whether an interdisciplinary palliative care intervention in addition to evidence-based HF care improves certain outcomes. METHODS We randomized 150 patients with advanced HF between August 15, 2012, and June 25, 2015, to usual care (UC; n =75) or UC plus a palliative care intervention (UC+PAL; n =75) at a single center. Primary endpoints were 2 quality-of-life measurements, the Kansas City Cardiomyopathy Questionnaire (KCCQ) overall summary and the Functional Assessment of Chronic Illness Therapy - Palliative Care scale (FACIT-Pal), assessed at 6 months. Secondary endpoints included assessments of depression and anxiety (measured via the Hospital Anxiety and Depression Scale [HADS]), spiritual well-being (measured via the FACIT - Spiritual Well-Being scale [FACIT-Sp]), hospitalizations, and mortality. RESULTS Patients randomized to UC+PAL versus UC alone had clinically significant incremental improvement in KCCQ and FACIT-Pal scores from randomization to 6 months (KCCQ difference =9.49 points, 95% CI 0.94 to 18.05, p =0.030; FACIT-Pal difference =11.77 points, 95% CI 0.84 to 22.71, p =0.035). Depression improved in UC+PAL patients (HADS-depression difference =−1.94 points; p =0.020) versus UC-alone patients, with similar findings for anxiety (HADS-anxiety difference =−1.83 points; p =0.048). Spiritual well-being was improved in UC+PAL versus UC-alone patients (FACIT-Sp difference =3.98 points; p =0.027). Randomization to UC+PAL did not affect rehospitalization or mortality. CONCLUSIONS An interdisciplinary palliative care intervention in advanced HF patients showed consistently greater benefits in quality of life, anxiety, depression, and spiritual well-being compared with UC alone. Trial Registration ClinicalTrials.gov Identifier: NCT01589601

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Section: Discussionmentioning

confidence: 99%

Palliative Care in Heart Failure

Rogers

Patel

Mentz

et al. 2017

Journal of the American College of Cardiology

455

110

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“…Therefore, comprehensive advance care planning should be a dynamic, iterative process rather than a singular event in time. A clinical trial is in progress exploring how to improve such communication between clinicians and ICD patients [NCT01459744] …”

Section: Determining Goals Of Carementioning

confidence: 99%

Putting the “Informed” in the informed consent process for implantable cardioverter‐defibrillators: Addressing the needs of the elderly patient

Eiser

Kirkpatrick

Patton

et al. 2018

Pacing Clinical Electrophis

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Implantable cardioverter defibrillator (ICD) management complexities challenge the ethos of fully informed consent, particularly for the typically multimorbid elderly patient considering the device for primary prevention. The Heart Rhythm Society recommends providers include discussion on the potential need for later device deactivation or nonreplacement at the time of first implant, and to revisit this at appropriate intervals. The initial consent procedure could meet this standard by incorporating the future need to discuss further such issues when the recipient's clinical condition changes to such an extent that defibrillation would no longer be beneficial. At the time of obtaining consent, some patients may lack the will or capacity to make medically complex decisions when it would be necessary for healthcare surrogate decision-makers to contribute to this process. Ensuring an appropriate level of understanding and response may be enhanced by the use of information and decision aids. With improved communication regarding the nuances of ICD therapy, device eligible patients, and those close to them, will be empowered with a better understanding of the nature, benefits, and risks of ICD implantation, allowing them to make treatment decisions consistent with their values.

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“…Trials such as the WISDOM trial aim to improve communication between the provider and the patient/caregiver with the goal of increasing conversations about deactivating ICDs, increasing ICD deactivations at the end of life, and improving psychological outcomes of bereaved caregivers. 25 The challenge with communication interventions is convincing clinicians that they need to improve their communication skills. In particular, many clinicians already believe that they are doing shared decision making.…”

Section: The Clinical/applied Research Of Decision Making – T2mentioning

confidence: 99%