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Phase 2 Randomised Controlled Trial and Feasibility Study of Future Care Planning in Patients with Advanced Heart Disease.

Denvir MA, Cudmore S, Highet G, Robertson S, Donald L, Stephen J, Haga K, Hogg K, Weir CJ, Murray SA, Boyd K - Sci Rep (2016)

Bottom Line: Future Care Planning (FCP) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost.FCP did not increase anxiety/distress (Kessler score -E 16.7 (7.0) vs D 16.8 (7.3), p = 0.94).Qualitative interviews indicated that FCP was highly valued by patients, carers and family physicians.

View Article: PubMed Central - PubMed

Affiliation: Cardiology, Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, EH16 4SA, UK.

ABSTRACT
Future Care Planning (FCP) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost. We assessed the feasibility, acceptability and tested a design of a randomised trial evaluating the impact of FCP in patients and carers. 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of >20% were randomly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks. Quality of life, symptoms and anxiety/distress were assessed by questionnaire. Hospitalisation and mortality events were documented for 6 months post-discharge. FCP increased implementation and documentation of key decisions linked to end-of-life care. FCP did not increase anxiety/distress (Kessler score -E 16.7 (7.0) vs D 16.8 (7.3), p = 0.94). Quality of life was unchanged (EQ5D: E 0.54(0.29) vs D 0.56(0.24), p = 0.86) while unadjusted hospitalised nights was lower (E 8.6 (15.3) vs D 11.8 (17.1), p = 0.01). Qualitative interviews indicated that FCP was highly valued by patients, carers and family physicians. FCP is feasible in a randomised clinical trial in patients with acute high risk cardiac conditions. A Phase 3 trial is needed urgently.

No MeSH data available.


Related in: MedlinePlus

Change in Process Outcomes during the intervention for early and delayed groups.Proportion (%) of patients in early and delayed arms of the trial with completion of each of the process measures included in the intervention which were discussed and documented in the written Future Care Plan at baseline, 12 and 24 weeks after discharge.
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f2: Change in Process Outcomes during the intervention for early and delayed groups.Proportion (%) of patients in early and delayed arms of the trial with completion of each of the process measures included in the intervention which were discussed and documented in the written Future Care Plan at baseline, 12 and 24 weeks after discharge.

Mentions: Components of the Future Care Plan were achieved more frequently in the early intervention group compared to the delayed intervention group by 12 weeks after discharge (Fig. 2). More patients in the early intervention group had an anticipatory care plan for acute deterioration, a nominated Power of Attorney, a record of CPR discussions, a record of preferred place of care and preferred place of death compared to the delayed group. More patients in the early group were added to the GP palliative care register and more had a care summary shared across primary, secondary and emergency care services by 12 weeks after discharge. These differences had reduced but were still present at 24 weeks following discharge (see supplementary Table 2).


Phase 2 Randomised Controlled Trial and Feasibility Study of Future Care Planning in Patients with Advanced Heart Disease.

Denvir MA, Cudmore S, Highet G, Robertson S, Donald L, Stephen J, Haga K, Hogg K, Weir CJ, Murray SA, Boyd K - Sci Rep (2016)

Change in Process Outcomes during the intervention for early and delayed groups.Proportion (%) of patients in early and delayed arms of the trial with completion of each of the process measures included in the intervention which were discussed and documented in the written Future Care Plan at baseline, 12 and 24 weeks after discharge.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4836296&req=5

f2: Change in Process Outcomes during the intervention for early and delayed groups.Proportion (%) of patients in early and delayed arms of the trial with completion of each of the process measures included in the intervention which were discussed and documented in the written Future Care Plan at baseline, 12 and 24 weeks after discharge.
Mentions: Components of the Future Care Plan were achieved more frequently in the early intervention group compared to the delayed intervention group by 12 weeks after discharge (Fig. 2). More patients in the early intervention group had an anticipatory care plan for acute deterioration, a nominated Power of Attorney, a record of CPR discussions, a record of preferred place of care and preferred place of death compared to the delayed group. More patients in the early group were added to the GP palliative care register and more had a care summary shared across primary, secondary and emergency care services by 12 weeks after discharge. These differences had reduced but were still present at 24 weeks following discharge (see supplementary Table 2).

Bottom Line: Future Care Planning (FCP) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost.FCP did not increase anxiety/distress (Kessler score -E 16.7 (7.0) vs D 16.8 (7.3), p = 0.94).Qualitative interviews indicated that FCP was highly valued by patients, carers and family physicians.

View Article: PubMed Central - PubMed

Affiliation: Cardiology, Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, EH16 4SA, UK.

ABSTRACT
Future Care Planning (FCP) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost. We assessed the feasibility, acceptability and tested a design of a randomised trial evaluating the impact of FCP in patients and carers. 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of >20% were randomly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks. Quality of life, symptoms and anxiety/distress were assessed by questionnaire. Hospitalisation and mortality events were documented for 6 months post-discharge. FCP increased implementation and documentation of key decisions linked to end-of-life care. FCP did not increase anxiety/distress (Kessler score -E 16.7 (7.0) vs D 16.8 (7.3), p = 0.94). Quality of life was unchanged (EQ5D: E 0.54(0.29) vs D 0.56(0.24), p = 0.86) while unadjusted hospitalised nights was lower (E 8.6 (15.3) vs D 11.8 (17.1), p = 0.01). Qualitative interviews indicated that FCP was highly valued by patients, carers and family physicians. FCP is feasible in a randomised clinical trial in patients with acute high risk cardiac conditions. A Phase 3 trial is needed urgently.

No MeSH data available.


Related in: MedlinePlus