RCT of Palliative Care for Heart Failure and Lung Disease: David Bekelman and Lyndsay DeGroot

In a JAMA 2020 systematic review of palliative care for non-cancer serious illness, Kieran Quinn found many positives, as we discussed on our podcast and in our editorial.  He also found gaps, including very few studies of patients with lung disease, and little impact of trials on quality of life.  The article we discuss today, also published in JAMA, addresses these two gaps.

David Bekelman conducted a RCT of a nurse and social worker telephone intervention (ADAPT intervention) for people with heart failure and lung disease (COPD or ILD).  David has been conducting outpatient trials in this space for some time, such as the CASA study he mentions today, learning important lessons along the way.  This is the first study that is unequivocally positive, improving overall quality of life and depression.  Today we unpack this study, with the help of Lyndsay Degroot, a postdoc and nurse researcher focused on identifying the core aspects of the study and eventually testing the study in more diverse populations.  In the accompanying editorial written by Ashwin Kotwal, Lauren Hunt, and the guy singing on today’s podcast, we talk about the strengths and limitations of this study, something we “get into” with the authors toward the end of today’s podcast. We are also joined by Diah Martina, a palliative care doctor trying to grow palliative care in Indonesia, in part by starting a palliative care podcast in Indonesian (she was observing today).

You can also listen to an audio interview with Alex and JAMA Deputy Editor Preeti Malani about this study and the other RCT of default palliative care for hospitalized older adults with noncancer serious illness published in the same issue. Stay tuned for a GeriPal podcast with the authors of the other study next week.

Credit to my wife Cindy for piano on the audio-only version of Ben Rector’s The Best is Yet to Come. Enjoy!

-@AlexSmithMD