Advancing Symptom Alleviation With Palliative Treatment (ADAPT)
Heart Failure, Pulmonary Disease, Chronic Obstructive, Emphysema
About this trial
This is an interventional health services research trial for Heart Failure focused on measuring Quality of Life, Symptom Assessment, Palliative Care, Disease Management, Delivery of Health Care, Advance Care Planning
Eligibility Criteria
Inclusion Criteria:
- Veterans enrolled in VA Eastern Colorado Health Care System or VA Puget - Sound Health Care System
- Diagnosis of CHF, pulmonary fibrosis, or COPD in 2 years prior to enrollment
- High risk for hospitalization and death
- Poor quality of life
- Symptomatic
- Primary care or other provider who is willing to facilitate intervention medical recommendations
- Able to read and understand English
- Consistent access to and able to use a standard telephone
Exclusion Criteria:
- Previous diagnosis of dementia
- Active substance abuse
- Comorbid metastatic cancer
- Nursing home resident
- Heart or lung transplant or left ventricular assist device (LVAD)
- Currently receiving hospice, palliative or home-based primary care
- Currently pregnant
- Currently a prisoner
Sites / Locations
- Rocky Mountain Regional VA Medical Center, Aurora, CO
- VA Puget Sound Health Care System Seattle Division, Seattle, WA
Arms of the Study
Arm 1
Arm 2
Experimental
No Intervention
ADAPT Intervention
Enhanced usual care
The intervention includes 3 components: nurse (RN) follows structured algorithms to help patients with symptoms, specifically breathlessness, fatigue, and pain. social worker provides structured counseling targeting adjustment to illness and depression and advance care planning. collaborative care model of care delivery, in which the nurse and social worker meet weekly with a primary care provider and palliative care specialist. This team makes medical recommendations to the intervention subjects' providers and supervises the nurse and social worker. The team has as-needed consultation with a cardiologist or pulmonologist. The nurse and social worker visits are in-person or by phone.
Patients in the control group will continue to receive care at the discretion of their providers, which may include referrals to and ongoing care from cardiology, pulmonary, palliative care, or mental health. They will also have the same amount of interaction with research assistants as the intervention patients, completing questionnaires and participating in study visits at the same frequency. Patients' providers will be given the results of baseline depression surveys if they screen positive for depression, and patients will be given an information sheet that outlines self-care for CHF or COPD.