Team-Based Palliative Telecare Led to Improved Quality of Life in Veterans with Chronic Lung Disease and Heart Failure
BACKGROUND:
Many Veterans with chronic obstructive pulmonary disease (COPD), heart failure (HF), or interstitial lung disease (ILD) endure poor quality of life despite conventional therapy. This clinical trial determined the effect of a nurse and social worker palliative telecare team on quality of life in outpatient Veterans with COPD, HF, or ILD compared to usual care. Using electronic health record data to identify eligible participants, researchers enrolled Veterans (October 2016 – April 2020) in two VA healthcare systems (Colorado and Washington). Participants were 306 Veterans (mean age 69, 90% male, 80% white) with COPD (58%), HF (22%), COPD and HF (16%), or ILD (4%) at high risk of hospitalization or death who reported poor quality of life. The intervention involved six phone calls with a nurse to help with symptom management and six phone calls with a social worker for psychosocial care. The nurse and social worker met weekly with a study primary care and palliative care physician, and as needed, a pulmonologist and cardiologist. Usual care included an educational handout on self-care for COPD, HF, or ILD. The primary outcome was the difference in the change in the quality-of-life score from baseline to six months between the intervention and usual care. Secondary outcomes included disease-specific health status, and depression and anxiety symptoms.
FINDINGS:
- Veterans who received the palliative telecare team intervention reported significantly improved quality of life at six months compared with Veterans who received usual care (mean quality of life score improvement of six points vs. one point; a clinically meaningful difference is four points).
- The positive intervention effect on quality of life began early, at 4 months, and persisted at 12 months.
- The intervention also improved COPD and HF health status, and depression and anxiety at six months.
IMPLICATIONS:
- The virtual and population approach of this intervention can improve the reach of palliative care services in traditionally under-resourced areas.
LIMITATIONS:
- The high proportion of male participants might limit the external validity of the study findings.
AUTHOR/FUNDING INFORMATION:
This study was funded by HSR&D (IIR 14-346). Dr. Bekelman, Mr. Feser, and Ms. Morgan are with the Seattle-Denver Center of Innovation for Veteran-Centered & Value-Driven Care in Colorado.
Bekelman DB, Feser W, Morgan B, et al. Nurse and Social Worker Palliative Telecare Team and Quality of Life in Patients with COPD, Heart Failure, or Interstitial Lung Disease: The ADAPT Randomized Clinical Trial. JAMA. January 16, 2024;331(3):212-223.
