A pilot randomized controlled trial of a palliative care education intervention compared to usual care on health literacy and quality of life among older adults with chronic obstructive pulmonary disease: the paced study
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Abstract
Adults 65 years of age and older (older adults) with chronic obstructive pulmonary disease (COPD) are living longer, report lower health literacy, experience poorer quality of life (QOL), and seek emergency department care for relief of symptoms such as breathlessness, dyspnea, pain, and anxiety. Uncertainty about illness progression can affect patients' ability to understand health information and make informed decisions impacting QOL. Limited research exists on health literacy and QOL related to palliative care education in emergency departments, making it a healthcare priority. Online education for older adults is effective for increasing healthcare knowledge. The purpose of this pilot randomized controlled trial feasibility study was to test the study research protocol including the intervention or usual care, instruments, recruitment, retention, attrition and to identify trends in health literacy and QOL in older adults with COPD seeking treatment in an emergency department who were randomized into the four-week online standardized palliative care educational intervention or usual care. The expanded chronic care model combined with palliative care constructs provided the theoretical foundation for this study. Feasibility data were collected during the study and feasibility questions were assessed at study completion. The Short Form-36, which measured QOL and the health literacy questionnaire, which measured health literacy, were administered at baseline and at study completion. Of 190 patients screened, 35 met inclusion criteria and were randomly assigned (1:1) to either the intervention (n=17) or usual care (n=18). Attrition was 74% overall with 72% from the intervention group and 82% from the usual care group. Eight participants completed the study, five in intervention and three in usual care. Of these eight, 35% were male, 88% were Caucasian and 35% had a college education. All five intervention participants accessed each of the four palliative care educational videos. All study surveys were completed with no missing data. Within and between groups, QOL and health literacy trends were unable to be identified due to small sample sizes. In conclusion, protocol modifications are needed for future study success. Testing palliative care educational interventions for older adults with COPD treated in the emergency department remains an important goal.
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Introduction -- Literature review -- Methodology -- Results -- Discussion
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Ph.D. (Doctor of Philosophy)