On-going palliative care enhances perceived control and patient activation and reduces symptom distress in patients with symptomatic heart failure: A pilot study

Abstract

Introduction: There is a paucity of research about the impact of palliative care (PC) on perceived control (i.e. onesperceived influence over outcomes or events in the environment) and activation (i.e. ability to self-manage) in patientswith symptomatic heart failure (HF). Likewise, little is known about the association between perceived control, activation,and symptom distress in this patient population. We hypothesized that patients with advanced HF who received ongoingPC services (i.e. ≥2 PC consultations) vs no access or a single PC consultation would have greater improvementsin perceived control and activation and greater reductions in symptom distress three months post-discharge for HFexacerbation. Methods: Forty-two patients (average age 53.98.0 years; predominantly male (72%), White (61%) and married (69%))participated in the study. However, only 36 (85.7%) patients completed an outpatient PC consultation of which 29 (69%) patients returned for additional follow-up visits with the PC team. Data on perceived control, activation, and symptomdistress were collected at baseline and three months. Parametric statistical models were applied to draw conclusions. Results: Findings showed that the patients who received ≥2 PC consultations had greater improvements in perceivedcontrol and activation than their counterparts; these increases were associated with greater reductions in symptomdistress. Conclusion: Our findings suggest that on-going PC interventions enhance perceived control and activation in patientswith advanced HF and open up the possibility of planning larger studies to assess the effect of PC on these variables aspossible mediators to improvements in self-management and clinical outcomes. © The European Society of Cardiology 2014.