Implementing Community-Based Palliative Care for Adults with Heart Failure or Chronic Obstructive Pulmonary Disease
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PROJECT SUMMARY/NARRATIVE: Heart failure (HF) or chronic obstructive pulmonary disease (COPD) affects over 20 million U.S. adults, leading to persistent symptoms, emotional distress, and fragmented care that result in poor quality of life and high healthcare utilization. While HF and COPD guidelines advocate for early palliative care integration into routine ambulatory care, most patients do not receive it outside of inpatient or end-of-life settings. Dr. DeGroot's long-term goal is to become an independent nurse scientist who implements and disseminates evidence-based palliative care interventions to improve care and outcomes for individuals with HF or COPD. To advance this goal, this career development award will provide advanced training in dissemination and implementation science, mixed methods, and pragmatic clinical trials. Dr. DeGroot will apply this training in the proposed mixed-methods feasibility study examining the implementation of an evidence-based palliative care intervention, Advancing Symptom Alleviation with Palliative Treatment (ADAPT) in a community care setting. This efficacious nurse and social work telecare intervention improved quality of life, disease-specific health status, depression, and anxiety in veterans with HF or COPD. However, ADAPT has not been implemented outside the Veterans Health Administration and has not been delivered by routine providers in community care settings. Guided by the Practical Robust Implementation and Sustainability Model (PRISM), this mixed methods feasibility study aims to 1) explore the context and develop strategies to implement ADAPT by providers in a community care organization, and 2) evaluate the implementation of ADAPT in community care. This study aligns with the NHLBI strategic plan to improve access to high-quality, evidence-based care that improves quality of life, and addresses HF and COPD guidelines advocating for earlier palliative care integration. Findings will generate preliminary data to inform future implementation studies of ADAPT in community settings, advancing Dr. DeGroot's career development as a nurse scientist focused on implementing evidence-based palliative care into routine community care to improve the quality of life for people with HF or COPD.
