For a study, researchers sought to determine if a collaborative palliative care intervention improved the quality of life in outpatients with HF, COPD, or ILD when compared to standard treatment. Within two VA health care systems, they performed a single-blind, two-arm, multisite randomized clinical study. Outpatients with HF, COPD, and ILD who were at high risk of hospitalization or mortality and had low QOL were included. A nurse provided symptom treatment, while a social worker offered psychosocial care as part of the intervention. In a study, the main care and palliative care physician, pulmonologist, and cardiologist met weekly with the nurse and social worker. The primary outcome was the difference in improvement in QOL between intervention and standard care from baseline to 6 months (FACT-G score, range 0-100, higher score better, clinically relevant change 4-6 points). The intent-to-treat approach and mixed models were used in the analysis.
About 306 patients were enrolled in total (154 intervention, 152 usual care). Participants were mostly men (90.2%) and white (80.1%), with an average age of 68.9 (SD 7.7) years; 57.8% had COPD, 21.9% had HF, and 16% had combined COPD/HF, and 4.2% had ILD. FACT-G baseline scores were comparable (intervention, 52.9; usual care, 52.7). At 6 months, both the intervention and usual care groups completed the FACT-G. 112/154 (73%) of patients in the intervention group completed the scheduled intervention. At 6 months, the intervention arm’s mean FACT-G score increased by 6.0 points, and the usual care arm’s improved by 1.4 points (difference, 4.6; 95% CI 1.8, 7.4; P=0.001; standardised effect size [ES], 0.41). At all time intervals, this impact was seen (4-month ES 0.30, P=0.02; 12-month ES 0.36, P=0.007). For high-risk outpatients with heart and lung illnesses, a coordinated palliative care strategy exhibited early, sustained, clinically relevant improvements in QOL.
Reference:www.jpsmjournal.com/article/S0885-3924(22)00494-8/fulltext
