Article Text
Abstract
Patients with chronic heart failure (CHF) have symptoms and concerns which are inadequately addressed. Patient-reported outcome measures (PROMs) can potentially improve the identification and management of advanced symptoms and palliative concerns. However, these have not been used in CHF.
Objectives To examine the feasibility and acceptability of using a PROM—the Integrated Palliative care Outcome Scale (IPOS)—together with heart failure nurse education and training to improve the identification and management of symptoms and concerns among patients with CHF.
Methods A parallel, mixed methods design with an embedded qualitative component was used to examine the feasibility of recruitment, retention, intervention adherence/compliance and follow-up assessment completion (symptom burden, quality of life, psychological well-being). Patient and nurse qualitative semistructured interviews explored intervention and study design feasibility and its acceptability.
Results Conversion to consent was 46.9% (372 screened, 81 approached, 38 recruited). 66% of patient participants completed the IPOS; 6% of IPOS questionnaire items were missing (non-response). Over two-thirds (65.6%) of these missing items related to three patients. No item was consistently missing; appetite was the most frequent missing item (1.4%). 92% of participants who completed the IPOS completed all follow-up assessments (1–2 days, 1–2 weeks and 4–6 weeks post-IPOS completion) with no missing data. The a priori feasibility objectives were met. Patients and nurses reported the intervention and study design feasible and acceptable.
Conclusions A palliative-specific PROM-based intervention is feasible and acceptable to both patients with CHF and nurses in nurse-led disease management clinics for the purposes of both clinical care and research.
- heart failure
- feasibility
- acceptability
- palliative care
- patient-reported outcome measure
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Footnotes
Contributors PMK was involved in the conception and design of this study, planning, data collection and analysis and manuscript development and revision. CIES was involved in data analysis, development of the figures and tables, manuscript development and revision. CT, GOG, CR and CH were involved in the data collection, development of the figures and tables, manuscript development and revision. BAD and FEM were involved in the conception and design of this study, planning, data analysis, development of the figures and tables, manuscript development and revision. KR, NM, BMA, RM, IJH and JK were involved in the planning, development of the figures and tables, manuscript development and revision.
Funding This work was supported by the National Institute for Health Research (NIHR) under the Programme Grants for Applied Research programme grant number (RP-PG-1210-12015 C-CHANGE) and the NIHR Collaboration for Leadership in Applied Health Research & Care (CLAHRC) through CLAHRC South London. This paper presents independent research funded by BuildCARE and part-funded BuildCARE is supported by Cicely Saunders International (CSI) and Atlantic Philanthropies, and led by King’s College London, CSI, UK.
Competing interests None declared.
Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.
Ethics approval Research Ethics Committees at each of King’s College London, Beaumont Hospital and Mater Misericordiae University Hospital.
Provenance and peer review Not commissioned; externally peer reviewed.