Heart Failure
Conditions
Keywords
Advanced care planning, End of life care
Brief summary
Aims: Advance care planning (ACP) is considered to be one of the most promising interventions to enable patients with life limiting illnesses to receive treatment at the end of life (EOL) according to their own preferences and to promote EOL conversations between patients and their health care providers. Through a 2-arm randomized controlled trial (RCT) of patients with Class III and IV heart failure (New York Heart Association Functional Classification), we propose to assess: 1. Whether patients in the ACP arm have a greater likelihood of receiving EOL care consistent with their preferences as stated in the latter of the last ACP document or the last patient interview, compared to patients in the control arm. 2. Heath care costs during study duration between patients in ACP and control arms. 3. Patient's understanding of own illness and their participation in decision making between the ACP and control arms. 4. Patient's quality of life, anxiety and depression between ACP and control arms. Methodology: A total of 254 patients with advance heart failure will be randomized to receive intervention (ACP arm; N=127) or usual care (control arm; N=127). The RCT will be conducted at the National Heart Centre and Singapore General Hospital. Patients in both arms will be followed for one year or till death, whichever is earlier, and interviewed every 4 months during this duration. Clinical Significance: If benefits of ACP are shown to add value through this trial, then this study will help to promote acceptance of ACP among patients and health care providers across Singapore and elsewhere.
Interventions
BEHAVIORALACP
Sponsors
National Heart Centre Singapore
Singapore General Hospital
Duke-NUS Graduate Medical School
Study design
Allocation
RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
21 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patient participant: * Patients must be 21 years old or older and must be diagnosed with advanced heart failure (New York Heart Association Class III and IV). Patients must be aware of their diagnosis * Caregiver/Decision-maker participant: Subject must be 21 years old or older Participant must be either * appointed substitute decision maker or * most likely to be substitute decision maker for patient (if patient were to lose decision-making capacity)
Exclusion criteria
* Patient participant: Patients must not have any psychiatric or cognitive disorders * Caregiver/Decision-maker participant: Cannot be a maid or foreign domestic worker
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of patients receiving end of life care consistent with their stated preferences | one year | Patient's stated preferences for cardiopulmonary resuscitation (CPR) and life prolonging treatments (e.g. mechanical ventilation, dialysis, feeding tube, intravenous antibiotics, blood transfusion) will be assessed from their last survey or their ACP document. The actual treatment received by the patient will be assessed from medical records after the patient's death. Proportion of patients who died and received treatment consistent with their stated preferences will be calculated and compared between ACP and control arms |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Total health care expenditure of patients during study duration | one year | Total healthcare expenditures during the study duration will be assessed from institutional databases and compared between ACP and control arms. |
| Patient scores for Quality of life | every four months for one year | Quality of life will be assessed through McGill Quality of Life scale and compared between ACP and control arms. |
| Patient's understanding of own illness | every four months for one year | Patient's understanding of own prognosis will be assessed and compared between ACP and control arms. |
| Patient scores for anxiety and depression | every four months for one year | Patient's anxiety and depression will be assessed through Hospital Anxiety and Depression scale and scores will be compared between ACP and control arms. |
| Patient's participation in decision-making | every four months for one year | Patient scores on decision conflict scale will be assessed and compared between ACP and control arms. |
Countries
Singapore
Outcome results
None listed