Transitional Palliative Care in End-stage Heart Failure

The Hong Kong Polytechnic University

Status: Completed

Conditions: End Stage Heart Disease; Heart Failure

Treatments: Behavioral: Transitional Care Model; Behavioral: Usual care

Study type: Interventional

Funder types: Other

Identifiers

NCT02086305

PolyU5492

Details and patient eligibility

About

Palliative care for end-stage organ failure patients has been included as one of the key programs to be implemented in 2011-2012 in the Hospital Authority, Hong Kong. Among all the disease groups, end-stage heart failure patients have the highest mortality rate. Patients at the end stage of heart failure have health concerns shared by other end-stage patients including cancer patients. Many guidelines, local and world-wide, have advocated a palliative approach of care for those heart failure patients who are at end stage. Studies have shown that end-stage heart failure patients tend to have frequent emergency room visits and repeated hospital admissions. Also, these patients suffer from a number of health problems that adversely affect their Quality Of Life.

There is scarcity of experimental studies informing practitioners which models work best for palliative patients in Hong Kong. There were randomized controlled trials conducted outside Hong Kong which suggest multidisciplinary approach of palliative care is possible to reduce readmissions but evidence is not present for other outcomes such as symptom control and carer burden.

In an attempt to fill knowledge gap and inform practice using evidence, this study is launched to compare the effects of a customary hospital-based palliative heart failure care and an interventional Home-based Palliative heart failure Program.

Hypothesis

• there is no difference in health care utilization for end-stage heart failure patients between the customary hospital-based group and the Home based palliative heart failure program group
• there is no difference in evaluated health outcomes (functional status, symptom intensity, and satisfaction with care) between the customary hospital-based group and the Home based palliative heart failure program group
• there is no difference in perceived health outcomes (quality of life, caregiver burden) between the customary hospital-based group and the Home based palliative heart failure program group
• there is no difference in cost effectiveness between the customary hospital-based group and the Home based palliative heart failure program group
• there is no difference In patients' lived experiences between the customary hospital-based group and the Home based palliative heart failure program group

Full description

As described

Enrollment: 84 patients

Sex: All

Volunteers: No Healthy Volunteers

Inclusion criteria

• Ability to speak Cantonese

• Living within the hospital service area

• Ability to be contacted by phone

• Identified as end-stage heart failure eligible for palliative care, guided by Prognostic Indicator Guidance, National Gold Standards Framework,to fulfill at least two of the indicators below:

  (i) Congestive heart failure New York Heart Association stage III or IV (ii) Patient thought to be in the last year of life by the care team (iii) Repeated hospital admissions with symptoms of heart failure (3 hospital admissions within one year) (iv) Existence of physical or psychological symptoms despite optimal tolerated therapy

Exclusion criteria

• Discharged to nursing home or other institution
• Inability to communicate
• Diagnosed with severe psychiatric disorders such as schizophrenia, bipolar disorder

Trial design

Primary purpose: Supportive Care

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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84 participants in 2 patient groups

Usual Care + Transitional Care Model

Experimental group

Description:

Transitional Care, Evidence-based symptom management, Protocol-driven home visit and telephone follow-up, Trained nurse case manager and volunteer partnership

Treatment:

Behavioral: Usual care

Behavioral: Transitional Care Model

Usual Care

Active Comparator group

Description:

Usual care

Treatment:

Behavioral: Usual care