Cystic Fibrosis
Conditions
Keywords
Pulmonary Cystic Fibrosis
Brief summary
Individuals living with cystic fibrosis (CF) commonly report high symptom burden, poor quality of life, and additional psychosocial stressors; these burdens are particularly heightened in advanced stages of the disease. Although supportive care (aka palliative care) has been shown to improve many of these outcomes among patients with illnesses such as cancer, no clinical trials to date have tested the impact of supportive care for patients with CF. The purpose of this pilot randomized clinical trial study is to evaluate the feasibility, acceptability, and perceived effectiveness of an embedded supportive care intervention, whereby a supportive care specialist will be integrated within the usual care experience of patients with advanced CF. The investigators will enroll 50 patients with advanced CF, who will be equally randomized to receive this embedded supportive care intervention or usual care. Secondary measures include: patient quality of life, mood, coping style, satisfaction with care, and symptom burden. This study will provide preliminary data to support the development of a larger, definitive, Phase III randomized clinical trial.
Detailed description
As described above.
Interventions
BEHAVIORALSupportive Care Intervention
Patients in the intervention arm of the study will see a SC specialist during regularly-scheduled CF clinic visits; per usual care, these visits should occur on a quarterly basis. Using a structured intervention manual, these visits will span 30-60 minutes each. Each visit will have a specific focus, such as: 1) comprehensive palliative care assessment; 2) symptom assessment and self-management; 3) advance care planning; and, 4) coping and resilience. Patients requiring follow up with SC before the next CF appointment will receive telephone follow up or an extra SC visit at the discretion of the SC provider.
Sponsors
Cystic Fibrosis Foundation
University of Pittsburgh
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Ability to comprehend English * Advanced CF (Any of the following criteria will be indicative of Advanced CF) * Baseline supplemental oxygen requirement * FEV1 ≤ 50% * Baseline non-invasive mechanical ventilation requirement * ≥ 2 hospitalizations in the past 12 months for respiratory complications related to CF
Exclusion criteria
* Prisoners * Females who are pregnant * Prior receipt of specialist SC services * Cognitive impairments * Patients younger than 18 years of age
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Intervention fidelity | Up to 9 months (+/- 4 weeks) | Evaluate the fidelity of intervention delivery using structured visit checklists to be completed by the interventionist and research staff. |
| Feasibility of intervention | Up to 9 months (+/- 4 weeks) | Measured by: eligibility rate, approach-to-consent rate, approach-to-enroll rate, rate of missed intervention sessions, rate of missing data on patient-reported outcomes. |
| Acceptability of intervention | Up to 9 months (+/- 4 weeks) | Measured by: proportion of participants who endorse the intervention as acceptable. |
| Perceived effectiveness of intervention | Up to 9 months (+/- 4 weeks) | Measured by: proportion of participants who endorse that they believe the intervention to have been beneficial. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Satisfaction with care | Up to 9 months (+/- 4 weeks) | Change in satisfaction with care from baseline using the FAMCARE-P13, reported at 0, 3, 6, 9 months. Due to the pilot nature of this trial, this measure will not be used to assess the efficacy of the intervention. |
| Symptom burden | Up to 9 months (+/- 4 weeks) | Change in symptom burden from baseline using the Edmonton Symptom Assessment Scale (ESAS), reported at 0, 3, 6, 9 months. Due to the pilot nature of this trial, this measure will not be used to assess the efficacy of the intervention. |
| Patient quality of life: Cystic Fibrosis Questionnaire-Revised (CFQ-R) | Up to 9 months (+/- 4 weeks) | Change in QOL from baseline as measured by the Cystic Fibrosis Questionnaire-Revised (CFQ-R) at 9 months. Due to the pilot nature of this trial, this measure will not be used to assess the efficacy of the intervention. |
| Patient mood | Up to 9 months (+/- 4 weeks) | Change in mood from baseline using the Hospital Anxiety and Depression Scale (HADS), reported at 0, 3, 6, 9 months. Due to the pilot nature of this trial, this measure will not be used to assess the efficacy of the intervention. |
| Coping style | Up to 9 months (+/- 4 weeks) | Change in coping style from baseline using the Brief COPE, reported at 0, 3, 6, 9 months. Due to the pilot nature of this trial, this measure will not be used to assess the efficacy of the intervention. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Healthcare utilization | Up to 12 months | The investigators will evaluate various measures of healthcare utilization, such as: ED visits, unplanned hospitalizations, and healthcare expenditures. |
Countries
United States
Outcome results
None listed