Effect of a Collaborative Palliative Care Intervention vs Usual Care on Quality of Life of Patients with Symptomatic Heart and Lung Diseases: A Randomized Clinical Trial (CO202A)

Outcomes. 1. Propose a primary palliative care approach to improve quality of life in chronic obstructive pulmonary disease and chronic heart failure 2. Compare quality of life outcomes from a randomized clinical trial of a primary palliative care intervention Importance. Patients with heart failure (HF), chronic obstructive pulmonary disease (COPD), and interstitial lung disease (ILD) endure poor quality of life (QOL) despite conventional therapy. Objective(s). Determine whether a collaborative palliative care intervention improves QOL in outpatients with HF, COPD, or ILD compared to usual care. Method(s). We conducted a single-blind, 2-arm, multisite randomized clinical trial within 2 VA health care systems. We included outpatients with HF, COPD, and ILD at high risk of hospitalization or death who reported poor QOL. The intervention included symptom care provided by a nurse and psychosocial care provided by a social worker. The nurse and social worker met weekly with a study primary care and palliative care physician, pulmonologist, and cardiologist. The primary outcome was difference in change in QOL from baseline to 6 months between intervention and usual care (FACT-G score, range 0-100, higher score better, clinically meaningful change ∼4-6 points). Analysis used the intent-to-treat approach and mixed models. Results. A total of 306 patients were enrolled (154 intervention, 152 usual care). Participants were generally male (90.2%), White (80.1%), with a mean age of 68.9 (SD 7.7) years; 57.8% had COPD, 21.9% HF, 16% both COPD/HF, 4.2% ILD. Baseline FACT-G scores were similar (intervention, 52.9; usual care, 52.7). FACT-G completion was 76% at 6 months for both intervention and usual care groups. In the intervention arm, 112/154 (73%) patients completed the planned intervention. At 6 months, mean FACT-G score improved by 6.0 points in the intervention arm and 1.4 points in the usual care arm (difference, 4.6; 95% CI 1.8, 7.4; p = 0.001; standardized effect size [ES], 0.41). This effect was observed at all time points (4-month ES 0.30, p = 0.02; 12-month ES 0.36, p = 0.007). Conclusion(s). A collaborative palliative care intervention demonstrated early, persistent, clinically meaningful improvements in QOL for high-risk outpatients with heart and lung diseases. Impact. A team primary palliative care approach increased the reach of palliative care for common, serious noncancer illnesses.