Palliative telecare team improves quality of life in COPD, ILD
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Key takeaways:
- Patients who received telecare from a nurse and social worker reported better quality of life vs. usual care.
- Disease-specific health status, depression and anxiety also improved with this intervention.
Receiving care from a palliative telecare team resulted in more improvements in quality of life than usual care among patients with COPD, interstitial lung disease or heart failure, according to study results published in JAMA.
“This new approach can reduce the burden of illness for patients,” David B. Bekelman, MD, MPH, professor of medicine and psychiatry at the University of Colorado School of Medicine at the Anschutz Medical Campus, told Healio.
“Many patients with COPD, heart failure or interstitial lung disease suffer from persistent symptoms (shortness of breath, fatigue) and depression and anxiety despite disease-specific treatments,” Bekelman continued. “We found that a palliative telecare team of a nurse and social worker, who collaborate with physicians, improved multiple quality of life outcomes for patients with these illnesses.”
In a single-blind, randomized trial of two Veterans Administration health care systems, Bekelman and colleagues assessed 306 outpatients (mean age, 68.9 years; 90.2% men; 80.1% white) with COPD, ILD or heart failure; self-reported poor quality of life; and a heightened risk for hospitalization or death to find out how palliative telecare from a nurse and social worker team (ADAPT intervention) impacts quality of life vs. usual care (educational handout).
Within the team, the nurse helped patients with symptom management, whereas the social worker offered psychosocial care to each patient. The nurse and the social worker each called the patient six times and met with each other, a primary care physician and a palliative care physician once a week. A pulmonologist and cardiologist joined the discussion if needed, according to researchers.
Researchers used Functional Assessment of Chronic Illness Therapy-General (FACT-G) questionnaire scores to assess how quality of life changed between baseline and 6 months in both groups. A score closer to 100 signaled better quality of life, whereas a score closer to zero signaled poor quality of life.
The cohort was split into the ADAPT intervention group (n = 154) and the usual care group (n = 152); however, only 112 of those from the intervention group completed a minimal dose of the intervention, including “nursing calls that included all nursing topics, all social work topics ... and a close-out call,” according to researchers.
Of the total cohort, more than half (n = 177; 57.8%) had COPD, with fewer patients with heart failure (n = 67; 21.9%), ILD (n = 13; 4.2%) and COPD plus heart failure (n = 49; 16%).
Primary Outcome
Researchers found comparable FACT-G scores between patients in the ADAPT group (52.9) and patients in the usual care group (52.7) at baseline.
At the 6-month mark, a little more than three-quarters of patients from each group completed the FACT-G questionnaire.
Among those receiving ADAPT, researchers reported that the intervention lasted for an average of 115.1 days, and the average number of phone calls was 10.4 per patient.
When evaluating FACT-G score changes, both groups showed improvement over 6 months, but patients receiving ADAPT had larger improvements than patients receiving usual care (mean change, 6 points vs. 1.4 points). The difference of 4.6 points (95% CI, 1.8-7.4) indicated a clinically meaningful change ( 4 points).
Comparing the two groups at 4 months and 12 months from baseline further showed that the ADAPT intervention led to more improvement in quality of life vs. usual care (4-month difference, 3.5 points; 95% CI, 0.6-6.4; 12-month difference, 4.9 points; 95% CI, 1.4-8.4).
“We were delighted to see that the improvement in quality of life lasted months after the intervention ended,” Bekelman said.
Secondary outcomes
In addition to quality of life, researchers analyzed changes in disease-specific health status using the Clinical COPD Questionnaire and the Kansas City Cardiomyopathy Questionnaire-12; depression symptoms using the Patient Health Questionnaire-8; and anxiety symptoms using the Generalized Anxiety Disorder-7 questionnaire between the two sets of patients.
Researchers found more improvement in COPD health status (standardized mean difference, 0.44; P = .04) and heart failure health status (0.41; P = .01) at 6 months among those in the ADAPT group vs. the usual care group.
Further, patients who talked to a nurse and social worker showed more improvement in depression (standardized mean difference, –0.5; P < .001) and anxiety (–0.51; P < .001) between baseline and 6 months than patients receiving usual care.
“I was surprised by the breadth of improvement for patients,” Bekelman told Healio. “Not only did overall quality of life improve, but also depression, anxiety and COPD- and heart failure-specific health status improved.”
The intervention was not linked to any adverse events or harm, according to researchers.
“Our next step is to work to implement this program into routine clinical care and maintain the benefits,” Bekelman told Healio.
Reference:
- Palliative telecare significantly improves quality of life for those with chronic illnesses, and results last for months. https://www.eurekalert.org/news-releases/1031214. Published Jan. 16, 2024. Accessed Jan. 16, 2024.