Study: Palliative Telecare Improves Quality of Life in Patients With Chronic Obstructive Pulmonary Disease, Heart Failure, or Interstitial Lung Disease

A recent study found that a nurse and social worker-led palliative telecare intervention significantly improved quality of life for outpatients with chronic obstructive pulmonary disease (COPD), heart failure (HF), or interstitial lung disease (ILD) who were at high risk of hospitalization or death. The intervention group demonstrated a clinically meaningful improvement in quality-of-life scores compared with usual care, with additional benefits observed in disease-specific health status, depression, and anxiety.

Patients with advanced lung and heart diseases often experience a poor quality of life despite standard therapies. Palliative care, typically reserved for end-of-life care, may provide significant benefits earlier in the disease course by addressing symptom burden and psychosocial needs. This study was conducted to determine whether a telecare approach involving a nurse and social worker could deliver these benefits effectively.

The researchers conducted a single-blind, randomized clinical trial across two Veterans Administration health systems, enrolling 306 outpatients between October 2016 and April 2020. Participants had COPD, HF, or ILD and were identified as high-risk due to poor quality of life and likely disease progression. The intervention group received six phone calls each from a nurse (focused on symptom management) and a social worker (providing psychosocial care) over approximately 4 months. Both professionals collaborated weekly with a multidisciplinary team, including primary care, palliative care, and relevant specialists. Usual care included a study-specific educational handout on self-management, alongside routine clinical care.

At baseline, quality of life scores, measured by the FACT-G scale (range, 0-100), were similar between the groups (52.9 in the intervention group vs. 52.7 in the usual care group). At 6 months, 76% of patients completed follow-up assessments. The intervention group showed a mean improvement of 6.0 points on the FACT-G scale, compared with a 1.4-point improvement in the usual care group (difference, 4.6 points [95% CI, 1.8-7.4]; P = .001; standardized mean difference, 0.41). Secondary outcomes also improved significantly in the intervention group, including disease-specific health status (e.g., COPD and HF questionnaires), depression (standardized mean difference, -0.50; P < .001), and anxiety (standardized mean difference, -0.51; P < .001).

The intervention’s limitations include its focus on a predominantly male veteran population, which may limit generalizability to broader groups. Additionally, the trial did not directly compare the telecare model to other forms of palliative care delivery.

“For adults with COPD, HF, or ILD who were at high risk of death and had poor quality of life, a nurse and social worker palliative telecare team produced clinically meaningful improvements in quality of life at 6 months compared with usual care,” the authors concluded.

Reference

Bekelman DB, Feser W, Morgan B, et al. Nurse and social worker palliative telecare team and quality of life in patients With COPD, heart failure, or interstitial lung disease: the ADAPT randomized clinical trial. JAMA. 2024;331(3):212-223. doi:10.1001/jama.2023.24035