An Intervention to Enhance Goals-of-Care Communication Between Heart Failure Patients and Heart Failure Providers

Ardith Z Doorenbos; Wayne C Levy; J Randall Curtis; Cynthia M Dougherty

doi:10.1016/j.jpainsymman.2016.03.018

An Intervention to Enhance Goals-of-Care Communication Between Heart Failure Patients and Heart Failure Providers

J Pain Symptom Manage. 2016 Sep;52(3):353-60. doi: 10.1016/j.jpainsymman.2016.03.018. Epub 2016 Jul 9.

Authors

Ardith Z Doorenbos¹, Wayne C Levy², J Randall Curtis², Cynthia M Dougherty³

Affiliations

¹ School of Nursing, University of Washington, Seattle, Washington, USA; School of Medicine, University of Washington, Seattle, Washington, USA. Electronic address: doorenbo@uw.edu.
² School of Medicine, University of Washington, Seattle, Washington, USA.
³ School of Nursing, University of Washington, Seattle, Washington, USA; School of Medicine, University of Washington, Seattle, Washington, USA.

Abstract

Context: Heart failure patients contend with a markedly impaired quality of life, experiencing emotional distress and severe physical discomfort that increases in frequency in the last months of life. Improving communication between patients and providers about goals of care has the potential to improve patient-provider communication and patient outcomes.

Objectives: To determine the effects of a goals-of-care (GoC) intervention compared to usual care on the number of GoC conversations, quality of communication between patients and providers, referrals to palliative care services and completion of advance care directives.

Methods: A two-group randomized study (n = 40/group) compared a GoC intervention to usual care, conducted in an academic heart failure (HF) clinic. The GoC intervention was a previsit patient activation-education, telephone-based intervention delivered by a nurse. The primary outcome of the study was number of GoC conversations between HF patients and HF providers. Secondary outcomes were quality of communication, number of referrals to palliative care, and completion of advance directives.

Results: Patients averaged 58.15 ± 11.26 years of age, with mean left ventricular ejection fraction = 30.31 ± 9.72% and Seattle Heart Failure Model scores = 95.1 ± 1.60. There was a significant increase in goals-of-care conversations (58% vs. 2.6%, P < 0.001) and quality of end-of-life communication (P = 0.03) in the GoC group compared to usual care after the intervention. There were no differences between groups on the other outcomes.

Conclusion: The GoC intervention resulted in more GoC conversations and higher quality communication between HF patients and providers without increased anxiety or depression. Further studies are needed to assess impact on longer term quality of care and patient outcomes.

Trial registration: ClinicalTrials.gov NCT02466100.

Keywords: Goals of care; communication; end of life; heart failure; palliative care.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

MeSH terms

Advance Directives
Communication*
Female
Heart Failure / psychology
Heart Failure / therapy*
Humans
Male
Middle Aged
Nurses
Palliative Care
Patient Care Planning*
Patient Education as Topic*
Professional-Patient Relations
Quality of Health Care
Referral and Consultation
Telemedicine*
Terminal Care
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT02466100

Grants and funding

K24 NR015340/NR/NINR NIH HHS/United States