Improving Symptoms and Quality of Life in Advanced Chronic Heart Failure

改善晚期慢性心力衰竭的症状和生活质量

• 批准号: 8705294
• 负责人: David B. Bekelman
• 金额: $ 33.58万
• 依托单位: DENVER RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-27 至 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8705294
• 关键词: Address; Affect; Algorithms; Caring; Cessation of life; Clinical Trials; Congestive Heart Failure; Development; Distress; Dyspnea; Economics; Enrollment; Equation; Family; Family Caregiver; Fatigue; Geographic Locations; Goals; Heart failure; Hospitalization; Intervention; Life; Link; Longitudinal Studies; Measures; Mediating; Mediation; Mental Depression; Minority; Modeling; Nurses; Outcome; Outcome Assessment; Outpatients; Pain; Palliative Care; Patients; Personal Satisfaction; Population; Protocols documentation; Provider; Psychosocial Assessment and Care; Public Health; Quality of life; Randomized Clinical Trials; Randomized Controlled Clinical Trials; Randomized Controlled Trials; Reporting; Research; Research Personnel; Self Care; Severities; Site; Social Workers; Specialist; Specific qualifier value; Structure; Symptoms; Testing; arm; care delivery; clinical care; collaborative care; cost; depressive symptoms; disability; evidence base; experience; health care service utilization; improved; innovation; meetings; multidisciplinary; palliative; primary outcome; symptom management; theories

DESCRIPTION (provided by applicant): Improving Symptoms and Quality of Life in Advanced Chronic Heart Failure Chronic heart failure (HF) patients suffer from numerous symptoms such as breathlessness, fatigue, and pain that worsen quality of life. Prior palliative symptom management interventions have generally not succeeded in improving symptoms in HF patients. Our preliminary studies show the importance and feasibility of providing psychosocial care to address the depression that intensifies other symptoms and integrating palliative care earlier into ongoing HF care. Adding these components to palliative symptom management offers a potentially successful strategy to reduce symptom severity and depression and thus improve quality of life in HF patients. This research is an integral part of a long term goal to improve symptoms and thus quality of life in patients with advanced HF. The specific aims of this proposal are to: (1) Assess the effect of a palliative symptom management and psychosocial care intervention on symptom severity and depression as primary endpoints, and symptom distress, adjustment to illness, self-care, and spiritual well-being as pre-specified secondary endpoints; (2) Evaluate whether the intervention influences quality of life indirectly through effects on symptom severity and depression. A 3-site, 2-arm randomized, controlled, clinical trial of 312 patients will be conducted in a single geographic region. Measures of symptom severity, depression, adjustment to illness, self-care, spiritual well-being, and quality o life will be collected at baseline, 3, 6, and 12 months. Hypotheses will be tested using mixed effects and structural equation models. Collectively, the proposed studies will impact clinical care for patients with HF by testing an innovative, evidence-based, theory-driven palliative symptom management and psychosocial care intervention and informing continued development of targeted interventions to improve outcomes. The core components of the intervention are structured to ease replication, implementation, and dissemination, and we plan subsequent studies to conduct an economic analysis of the intervention and to determine if the intervention has an effect on health care utilization and survival. This study will contribute to a key gap in HF and palliative care research and is directly linked to the goals of RFA-NR-11-006.

描述（由申请人提供）：改善晚期慢性心力衰竭的症状和生活质量慢性心力衰竭（HF）患者患有许多症状，如呼吸困难、疲劳和疼痛，这些症状使生活质量恶化。既往姑息性症状管理干预通常不能成功改善HF患者的症状。我们的初步研究表明，提供心理社会护理，以解决加重其他症状的抑郁症，并将姑息治疗早期纳入正在进行的HF护理的重要性和可行性。将这些成分添加到姑息性症状管理中提供了一种潜在的成功策略，以减轻症状严重程度和抑郁，从而改善HF患者的生活质量。这项研究是改善晚期HF患者症状和生活质量的长期目标的组成部分。本提案的具体目的是：（1）评估姑息性症状管理和心理社会护理干预对症状严重程度和抑郁的影响（作为主要终点），以及症状困扰、疾病适应、自我护理和精神健康（作为预先规定的次要终点）;（2）评估干预是否通过对症状严重程度和抑郁的影响间接影响生活质量。将在一个地理区域内对312例患者进行一项3中心、2组、随机、对照临床试验。将在基线、3、6和12个月时收集症状严重程度、抑郁、疾病适应、自我护理、精神健康和生活质量的指标。将使用混合效应和结构方程模型对假设进行检验。总的来说，拟议的研究将通过测试创新的、以证据为基础的、理论驱动的姑息性症状管理和心理社会护理干预来影响HF患者的临床护理，并为持续开发有针对性的干预措施以改善结局提供信息。干预的核心组成部分的结构，以方便复制，实施和传播，我们计划后续的研究进行干预的经济分析，并确定干预措施是否对医疗保健的利用和生存的影响。这项研究将有助于 HF和姑息治疗研究的关键差距，与RFA-NR-11-006的目标直接相关。

项目成果

Identifying critical psychotherapy targets in serious cardiac conditions: The importance of addressing coping with symptoms, healthcare navigation, and social support.

确定严重心脏病的关键心理治疗目标：解决症状、医疗保健导航和社会支持的重要性。

• DOI: 10.1017/s1478951518001037
• 发表时间: 2019
• 期刊: Palliative & supportive care
• 影响因子: 2.2
• 作者: Bekelman,DavidB;Knoepke,ChristopherE;Turvey,Carolyn
• 通讯作者: Turvey,Carolyn

Gender Differences in Sexual Interest or Activity among Adults with Symptomatic Heart Failure.

有症状心力衰竭成人的性兴趣或性活动的性别差异。

• DOI: 10.1089/jpm.2016.0476
• 发表时间: 2017
• 期刊: Journal of palliative medicine
• 影响因子: 2.8
• 作者: Fischer,Stacy;Bekelman,David
• 通讯作者: Bekelman,David

Preferred Role in Health Care Decision Making Over Time in Patients With Heart Failure: My Decision or My Doctor's Decision?

随着时间的推移，心力衰竭患者在医疗保健决策中的首选角色：我的决定还是我的医生的决定？

• DOI: 10.1016/j.cardfail.2022.03.357
• 发表时间: 2022
• 期刊: Journal of cardiac failure
• 影响因子: 6
• 作者: Deng,LubinR;Matlock,DanielD;Bekelman,DavidB
• 通讯作者: Bekelman,DavidB

The Impact of Relationship Quality on Health-Related Outcomes in Heart Failure Patients and Informal Family Caregivers: An Integrative Review.

• DOI: 10.1097/jcn.0000000000000270
• 发表时间: 2015-07-01
• 期刊: The Journal of cardiovascular nursing
• 作者: Hooker, Stephanie A;Grigsby, Megan E;Bekelman, David B
• 通讯作者: Bekelman, David B

Two Factor Structures Possible for the FACIT-Sp in Patients With Heart Failure.

• DOI: 10.1016/j.jpainsymman.2021.05.009
• 发表时间: 2021-11
• 期刊: Journal of pain and symptom management
• 影响因子: 4.7
• 作者: Deng LR;Masters KS;Schmiege SJ;Hess E;Bekelman DB
• 通讯作者: Bekelman DB