Advancing the Conversations Helpful for Awareness of Illness Trajectory (CHAT) Intervention

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PROJECT SUMMARY Heart failure with preserved ejection fraction (HFpEF) is a geriatric syndrome that disproportionately impacts older adults and is associated with high symptom burden, reduced quality of life, and a 5-year survival rate less than 50%. Yet, few patients with HFpEF understand the condition, its anticipated trajectory, and/or prognosis. This has several important implications, as our preliminary data show: (1) 33% of patients with a prior hospitalization for HFpEF are unaware that they have a form of heart failure; (2) symptom burden is high and engagement in symptom management is low; and (3) advanced care planning (ACP) is vastly underutilized among this patient population. Symptom management and ACP are key features of palliative care, but palliative care is either utilized at terminal disease stages or not at all. To address the urgent need to improve symptom management and ACP earlier in the disease than has traditionally been done, we developed the Conversations Helpful for Awareness of Illness Trajectory (CHAT) intervention. This intervention is grounded in self-determination theory, which outlines the importance of competence, autonomy, and relatedness in driving behavior change. CHAT will provide knowledge (competence), improve patient activation and self-efficacy (autonomy), and strengthen the patient-physician relationship (relatedness) through a combination of online patient-facing video-based modules using the Patient Activated Learning System (PALS) platform and a health coach who will guide patients through the online modules to promote active engagement. The objectives of this proposal are to: (1) refine the CHAT intervention by incorporating key stakeholders’ feedback through semi- structured qualitative interviews of patients, caregivers, and physicians, and (2) pilot test the CHAT intervention for feasibility, acceptability, and preliminary efficacy through a pilot randomized controlled trial. MPIs Goyal and Shen have complementary areas of expertise in HFpEF, implementation science, communication-based interventions, and social psychological frameworks. The investigator team also includes a primary care physician with expertise in intervention development who also created PALS, a nurse scientist with expertise in heart failure self-care and patient-reported outcomes, and a geriatrician/palliative care specialist with expertise in decision-making in heart failure and implementation science. The long-term objective is to develop a model for communicating illness trajectory to promote proactive patient engagement in managing symptoms (and improve QOL), and engagement in ACP. This proposal seeks to move beyond traditional siloed approaches of care to address the need to “incorporate palliative care approaches for aging-related conditions by healthcare practitioners who are not palliative care specialists.”