All ETDs from UAB

Advisory Committee Chair

Marie A Bakitas

Advisory Committee Members

Andres Azuero

Harleah Buck

Jnicholas Dionne-Odom

Keith M Swetz

Document Type

Dissertation

Date of Award

2019

Degree Name by School

Doctor of Philosophy (PhD) School of Nursing

Abstract

Heart failure (HF), a progressive condition with reduced quality of life (QoL) and high healthcare use, affects 6.5 million US adults. Research supports positive effects of palliative care integration into HF care, but there is limited consensus about the most beneficial intervention ‘dose’ (e.g. amount, duration, frequency, intensity). To date, no studies examining dose in palliative care HF interventions have been completed. Therefore, we examined dose using an existing data from the ENABLE CHF-PC trial (Educate, Nurture, Advise, Before Life Ends Comprehensive Heart Care for Patients and Caregivers; NCT02505425). Operationalizing dose as dichotomous complete/noncomplete of all intervention components (6-weekly, psychoeducational telephone sessions + one-time, in-person palliative care consultation), we examined ENABLE CHF-PC intervention dose effect on quality of life and healthcare use of advanced HF patients. We conducted an exploratory concurrent mixed methods study with 3 aims: 1) determine the relationship between ENABLE CHF-PC intervention dose and patient-reported (QoL) and healthcare use, 2) determine the relationship between ENABLE CHF-PC patients’ sociodemographic and clinical characteristics and intervention completion, and 3) explore ENABLE CHF-PC patients’ perspectives and experiences with intervention components, dose, and study outcomes. Linear mixed models were used to model intervention dose effect. Correlations and logistic regressions were used to examine associations between intervention completion and sociodemographic/clinical characteristics. Constant comparative analysis of semi-structured interviews was used to identify participant themes related to the intervention dose and study outcomes. Of 208 ENABLE CHF-PC patients randomized to receive the intervention, 127 (61.1%) did not complete all components. No significant sociodemographic and clinical differences were found between those who completed versus those who did not. Moderate, clinically significant effect size dose-related outcome differences were found at 16-weeks in QoL measures with improved QoL in those completing the intervention (between-group difference: -9.71 (3.18), d=0.47, p=0.002) but not healthcare use. An overarching theme of dose and study experience being filtered and influenced by disease-related, social, provider relationships, emotional, and logistical individual contexts emerged from the 45 semi-structured interviews. These findings suggest that increased exposure to early palliative care services may be beneficial; affecting QoL of certain subgroups of advanced HF patients in the Deep South.

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