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Social Worker-Aided Palliative Care Intervention in High-risk Patients With Heart Failure (SWAP-HF): A Pilot Randomized Clinical Trial
- Source :
- JAMA cardiology. 3(6)
- Publication Year :
- 2018
-
Abstract
- IMPORTANCE: Palliative care considerations are typically introduced late in the disease trajectory of patients with advanced heart failure (HF), and access to specialty-level palliative care may be limited. OBJECTIVE: To determine if early initiation of goals of care conversations by a palliative care–trained social worker would improve prognostic understanding, elicit advanced care preferences, and influence care plans for high-risk patients discharged after HF hospitalization. DESIGN, SETTING, AND PARTICIPANTS: This prospective, randomized clinical trial of a social worker–led palliative care intervention vs usual care analyzed patients recently hospitalized for management of acute HF who had risk factors for poor prognosis. Analyses were conducted by intention to treat. INTERVENTIONS: Key components of the social worker–led intervention included a structured evaluation of prognostic understanding, end-of-life preferences, symptom burden, and quality of life with routine review by a palliative care physician; communication of this information to treating clinicians; and longitudinal follow-up in the ambulatory setting. MAIN OUTCOMES AND MEASURES: Percentage of patients with physician-level documentation of advanced care preferences and the degree of alignment between patient and cardiologist expectations of prognosis at 6 months. RESULTS: The study population (N = 50) had a mean (SD) age of 72 (11) years and had a mean (SD) left ventricular ejection fraction of 0.33 (13). Of 50 patients, 41 (82%) had been hospitalized more than once for HF management within 12 months of enrollment. At enrollment, treating physicians anticipated death within a year for 32 patients (64%), but 42 patients (84%) predicted their life expectancy to be longer than 5 years. At 6 months, more patients in the intervention group than in the control group had physician-level documentation of advanced care preferences in the electronic health record (17 [65%] vs 8 [33%]; χ(2) = 5.1; P = .02). Surviving patients allocated to intervention were also more likely to revise their baseline prognostic assessment in a direction consistent with the physician’s assessment (15 [94%] vs 4 [26%]; χ(2) = 14.7; P
- Subjects :
- Male
medicine.medical_specialty
Social Work
Palliative care
Psychological intervention
Pilot Projects
030204 cardiovascular system & hematology
Patient Care Planning
law.invention
03 medical and health sciences
0302 clinical medicine
Quality of life (healthcare)
Randomized controlled trial
law
Medicine
Humans
030212 general & internal medicine
Prospective Studies
Prospective cohort study
Aged
Heart Failure
Intention-to-treat analysis
business.industry
Brief Report
Palliative Care
Patient Preference
Middle Aged
Prognosis
Hospitalization
Ambulatory
Emergency medicine
Life expectancy
Quality of Life
Female
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- ISSN :
- 23806591
- Volume :
- 3
- Issue :
- 6
- Database :
- OpenAIRE
- Journal :
- JAMA cardiology
- Accession number :
- edsair.doi.dedup.....6893e1cadd2712830d11fb532e628734