Effects of person‐centred and integrated chronic heart failure and palliative home care. PREFER: a randomized controlled study

Abstract

Aims We evaluated the outcome of person‐centred and integrated Palliative advanced home caRE and heart FailurE caRe (PREFER) with regard to patient symptoms, health‐related quality of life (HQRL), and hospitalizations compared with usual care. Methods and results From January 2011 to October 2012, 36 (26 males, 10 females, mean age 81.9 years) patients with chronic heart failure (NYHA class III–IV) were randomized to PREFER and 36 (25 males, 11 females, mean age 76.6 years) to the control group at a single centre. Prospective assessments were made at 1, 3, and 6 months using the Edmonton Symptom Assessment Scale, Euro Qol, Kansas City Cardiomyopathy Questionnaire, and rehospitalizations. Between‐group analysis revealed that patients receiving PREFER had improved HRQL compared with controls (57.6 ± 19.2 vs. 48.5 ± 24.4, age‐adjusted P‐value = 0.05). Within‐group analysis revealed a 26% improvement in the PREFER group for HRQL (P = 0.046) compared with 3% (P = 0.82) in the control group. Nausea was improved in the PREFER group (2.4 ± 2.7 vs. 1.7 ± 1.7, P = 0.02), and total symptom burden, self‐efficacy, and quality of life improved by 18% (P = 0.035), 17% (P = 0.041), and 24% (P = 0.047), respectively. NYHA class improved in 11 of the 28 (39%) PREFER patients compared with 3 of the 29 (10%) control patients (P = 0.015). Fifteen rehospitalizations (103 days) occurred in the PREFER group, compared with 53 (305 days) in the control group. Conclusion Person‐centred care combined with active heart failure and palliative care at home has the potential to improve quality of life and morbidity substantially in patients with severe chronic heart failure. Trial registration: NCT01304381

Strategies used in improving and assessing the level of reporting of implementation fidelity in randomised controlled trials of palliative care complex interventions: A systematic review

“…30,31,[61][62][63][64][65] Other strategies include role-play practice sessions with feedback to assess provider skill acquisition, [20][21][22]33 record and review of intervention sessions to assess provider skill maintenance, [20][21][22]33 assessment of providers' suitability for particular interventions 54 and appropriate training for trainees from different disciplines. 30,31,[61][62][63][64][65] For treatment delivery, key strategies are the usage of a treatment manual, [34][35][36] usage of an implementation checklist, [39][40][41][42][43][44] site visits/surveys to ensure adherence to intervention plan, 54,60 interviewing patients or caregivers on their experience, [23][24][25][26]29,32,45,[51][52][53]58 checking whether medications given were appropriate, 32,…”

Palliative care in heart failure: facts and numbers

“…The intervention included patient education around heart failure self care, advanced care planning, and frequent needs assessment that included physical, psychological, social, and spiritual issue needs. Needs assessment focused on heart failure and other comorbidities 37. The patients randomized to receive the intervention experienced a significant reduction in nausea ( P  = 0.02), better quality of life ( P  = 0.05), fewer hospitalizations ( P  = 0.009), and fewer days in hospital (103 vs. 305).…”

Person-Centered Healthcare - moving from rhetoric to methods, through implementation to outcomes

“…They increase the rates of patient self-help and management and either maintain or increase healthrelated quality of life. They are negatively correlated with clinician burn out rates and reduce malpractice claims [53][54][55][56][57][58][59][60][61].…”