Piamjariyakul Ubolrat, Young Stephanie, Smothers Angel, Wen Sijin, Navia R Osvaldo, Sokos George, Hendrickson Ann E, Fink Peggy, Niland Diana, Hottle Matthew, Giolzetti Angelo C, Smith Carol E
West Virginia University, School of Nursing, Office 6701, Post Office Box 9600, Morgantown, WV, USA.
Department of Biostatistics School of Public Health, West Virginia University, 64 Medical Center Drive, P.O. Box 9190, Morgantown, WV, USA.
BMC Palliat Care. 2025 Mar 7;24(1):56. doi: 10.1186/s12904-025-01680-y.
Heart failure (HF) is the leading cause of mortality, morbidity, and rehospitalization in Appalachia. Rural areas have the highest HF mortality rates. Rural Appalachians lack access to health services and end-of-life palliative care (EOLPC) and have extreme inequities in health.
The aim of this mixed methods randomized controlled trial (RCT) is to test the integrated nurse-led intervention bundle of the HF home EOLPC (HF-FamPALhomeCARE) and to assess its ability to maintain sustainability with rural stakeholders, visiting volunteers, and the WV Faith Community Nurse Network. The participants are adult patients (50 to 80 years) with HF (NYHA III and IV and Stages C and D) and their caregivers (≥ 45 to 80 years). The primary aim is to test the outcomes of patients with HF and family caregivers (104 dyads) managing home supportive EOLPC in rural WV. The secondary aim is to assess the bundled intervention for helpfulness, cost and sustainability. All participants received standard care from their regular providers. The intervention group received 2 home visits, 3 biweekly telephone calls and telephone reinforcement across 12 months. Data collection for both groups was conducted at baseline and at 3, 6, 9, and 12 months.
This RCT supports research to improve health equity by improving access to health services and addressing social determinants of health in underrepresented rural Appalachia. It is designed to test practical, sustainable approaches using available local resources to address HF symptom management, support EOLPC preferences, support older adults' functional health and HF home caregiving skills, and provide social support.
ClinicalTrials.gov NCT06791850 Registered on date 19 January 2025.
心力衰竭（HF）是阿巴拉契亚地区死亡、发病和再住院的主要原因。农村地区的心力衰竭死亡率最高。阿巴拉契亚农村地区居民难以获得医疗服务和临终姑息治疗（EOLPC），且在健康方面存在极端不平等。
这项混合方法随机对照试验（RCT）的目的是测试由护士主导的心力衰竭家庭临终姑息治疗综合干预方案（HF - FamPALhomeCARE），并评估其与农村利益相关者、来访志愿者和西弗吉尼亚州信仰社区护士网络维持可持续性的能力。参与者为患有心力衰竭（纽约心脏协会III级和IV级以及C期和D期）的成年患者（50至80岁）及其护理人员（≥45至80岁）。主要目的是测试西弗吉尼亚州农村地区患有心力衰竭的患者及其家庭护理人员（104对）管理家庭支持性临终姑息治疗的效果。次要目的是评估该综合干预方案的实用性、成本和可持续性。所有参与者均接受其常规医疗服务提供者提供的标准护理。干预组在12个月内接受2次家访、3次每两周一次的电话随访以及电话强化指导。两组的数据收集均在基线以及第3、6、9和12个月进行。
这项随机对照试验支持通过改善医疗服务可及性以及解决阿巴拉契亚农村地区代表性不足人群的健康社会决定因素来促进健康公平的研究。其旨在测试利用现有当地资源解决心力衰竭症状管理、支持临终姑息治疗偏好、支持老年人功能健康和心力衰竭家庭护理技能以及提供社会支持的实用且可持续的方法。
ClinicalTrials.gov NCT06791850，于2025年1月19日注册。
