•The decision-making preferences of patients with heart failure change over time.•A collaborative care intervention did not affect decision-making preferences.•Changes are not predicted well by ...various demographic and health-related factors.
Understanding patients’ preferred role in decision making can improve patient-centered care. This study aimed to determine change and the predictors of change in preferred decision-making roles over time in patients with heart failure.
During the CASA (Collaborative Care to Alleviate Symptoms and Adjust to Illness) trial, patients’ preferred roles in decision making were measured using the Control Preferences Scale (range 1–5; higher = less active; n = 312) at 4 timepoints over 1 year. The effect of the CASA intervention on preferred decision-making roles was tested using generalized linear mixed models. Whether preferences changed over time in the whole population was determined using linear regression. Demographic and health-related factors were examined as predictors of change using multiple linear regression. At baseline, most participants preferred active (score 1–2, 37.2%) or collaborative (score 3, 44.9%) roles. The CASA intervention did not influence preferred decision-making roles (P > 0.1). Preferences significantly changed over 1 year (P < 0.01), becoming more active (82.1%, 84.2%, 89.0%, 90.1% active/collaborative at each timepoint). Among all models and covariates, there were no significant predictors of change (P > 0.1).
Patients’ preferred roles in decision making change over time, but changes are not well predicted. Clinicians should frequently and directly communicate with patients about their preferred decision-making roles.
The Functional Assessment of Chronic Illness Therapy—Spiritual Well-Being Scale (FACIT-Sp) is a 12-item measure of spiritual well-being in chronic illness originally developed in patients with ...cancer. The overall scale, a two-factor model (meaning/peace, faith), and a three-factor model (meaning, peace, faith) have been proposed for the FACIT-Sp, and consensus on the best factor structure has not been reached. In addition, the factor structure of the FACIT-Sp has not been considered in patients with heart failure.
To examine the factor structure of the FACIT-Sp in heart failure patients.
A confirmatory factor analysis framework was used to test three competing models on 217 patients with heart failure using data from the CASA (Collaborative Care to Alleviate Symptoms and Adjust to Illness) trial. The overall scale (single factor), two-factor, and three-factor models were tested using baseline data, then confirmed with 12-month data. Model modifications were made based on empirical inspection of baseline data and replicated using 12-month data. Cronbach's alpha and correlations with measures of quality of life and psychological health were examined.
All three models had strong factor loadings on all items except the negatively worded items. The two-factor and three-factor models fit reasonably well after modifications, but the single factor did not fit well (1/2/3-factor: RMSEA 0.14/0.09/0.06, CFI 0.85/0.93/0.97, SRMR 0.09/0.05/0.04). Internal consistency was sufficient for all factors.
The two-factor and three-factor models were supported in heart failure patients. The three-factor model demonstrated better statistical fit but was not more interpretable.
This study investigated the factor structure of the FACIT-Sp in patients with heart failure. The two-factor and three-factor models were supported, but the single factor model was not. Negatively worded items did not perform well.
Background
Dyspnea is a common and debilitating symptom that affects many different patient populations. Dyspnea measures should assess multiple domains.
Objective
To evaluate the reliability, ...validity, and responsiveness of an ultra-brief, multi-dimensional dyspnea measure.
Design
We adapted the DEG from the PEG, a valid 3-item pain measure, to assess average dyspnea intensity (D), interference with enjoyment of life (E), and dyspnea burden with general activity (G).
Participants
We used data from a multi-site randomized clinical trial among outpatients with heart failure.
Main Measures
We evaluated reliability (Cronbach’s alpha), concurrent validity with the Memorial-Symptom-Assessment-Scale (MSAS) shortness-of-breath distress-orbothersome item and 7-item Generalized-Anxiety-Disorder (GAD-7) scale, knowngroups validity with New-York-Heart-Association-Functional-Classification (NYHA) 1-2 or 3-4 and presence or absence of comorbid chronic obstructive pulmonary disease (COPD), responsiveness with the MSAS item as an anchor, and calculated a minimal clinically important difference (MCID) using distribution methods.
Key Results
Among 312 participants, the DEG was reliable (Cronbach’s alpha 0.92). The mean (standard deviation) DEG score was 5.26 (2.36) (range 0-10) points. DEG scores correlated strongly with the MSAS shortness of breath distress-or-bothersome item (r=0.66) and moderately with GAD-7 categories (ρ=0.36). DEG scores were statistically significantly lower among patients with NYHA 1-2 compared to 3-4 mean difference (standard error): 1.22 (0.27) points, p<0.01, and those without compared to with comorbid COPD 0.87 (0.27) points, p<0.01. The DEG was highly sensitive to change, with MCID of 0.59-1.34 points, or 11-25% change.
Conclusions
The novel, ultra-brief DEG measure is reliable, valid, and highly responsive. Future studies should evaluate the DEG’s sensitivity to interventions, use anchor-based methods to triangulate MCID estimates, and determine its prognostic usefulness among patients with chronic cardiopulmonary and other diseases.
Few studies have examined how spiritual well-being changes over time in patients with heart failure. We conducted a secondary analysis of data from the Collaborative Care to Alleviate Symptoms and ...Adjust to Illness (CASA) trial (
N
= 314). Spiritual well-being was measured using the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp) at baseline and 12-month follow-up. Of the 165 patients with spiritual well-being data at follow-up, 65 (39%) experienced probable clinically meaningful changes (> 0.5 SD) in spiritual well-being (35 improved, 30 declined). Increased pain (
p
= 0.04), decreased dyspnea (
p
< 0.01), and increased life completion (
p
= 0.02) were associated with improvement in overall spiritual well-being. Exploratory analyses found different predictors for FACIT-Sp subscales.
High sensitivity and selectivity of C-doped WO 3 gas sensors are reported in this paper. C-doped WO 3 is synthesized by a facile infiltration and calcination process using the cotton fibers as ...templates. The response of C-doped WO 3 sensor toward toluene (50 ppm) and xylene (50 ppm) reach 91 and 199, respectively. By comparing the response of C-doped WO 3 sensor toward various indoor noxious gases (toluene, formaldehyde, ethanol, methane, benzene, and xylene), distinctive selectivity toward toluene and xylene is found. In addition, C-doped WO 3 exhibits relative hygro-stability, differing from traditional gas sensor material. The results indicate that C-doped WO 3 has good potential in practical applications, due to its remarkable performance and facile synthesized methods.
1. Describe themes in goals of care discussions with veterans.
2. Describe clinical implications for incorporating a communication guide into goals of care discussions.
Nurse and social worker-led ...telephone goals of care discussions can effectively explore patient goals, values, and preferences. Conversations were highly individualized, productive, and well-received by veterans.
While clinicians, patients, and governing bodies agree that goals of care discussions are essential to provide holistic, person-centered care, it is important to characterize patient responses to better execute these critical discussions. Recorded goals of care discussions offer a rich opportunity for qualitative analysis to reveal more about the dynamics of actual conversations in real-world, outpatient settings.
Evaluate goals of care discussions facilitated by a nurse or social worker using inductive thematic analysis.
Goals of care discussions led by a nurse or social worker were audio recorded for 141 veterans with chronic heart and lung diseases enrolled in a clinical trial. A semi-structured, 7-question communication guide was used to facilitate discussions. Recordings were randomly ordered and the first 27 meeting inclusion criteria for audio quality and content completeness were transcribed. Three independent coders created a codebook and iteratively developed emerging themes, which were further refined through team consensus.
Participants had a mean age of 66 years (SD 6), were 93% male, and 70% self-identified non-Hispanic white. The mean length of recordings was 51 minutes (SD 14). Four themes emerged: (1) participants expressed that the discussions were appreciated and meaningful; (2) participants’ sense of readiness to discuss their goals of care varied widely, yet many who expressed initial discomfort eventually engaged and identified goals; (3) participants’ goals were highly individualized and frequently achievable by adjusting their medical treatments; and (4) participants conflated medical and legal terminology.
A communication guide in the hands of skilled, trained nurses and social workers can lead to highly individualized discussions to inform treatment plans, enable clinicians to engage in whole-person care, and are well received by veterans.
A phone call with a nurse or social worker using a communication guide allowed people with heart failure and chronic lung diseases to explore and articulate goals of care.
Objectives 1. Describe how the FACIT-Sp should be used to measure spiritual well-being in patients with heart failure. 2. Recognize that the FACIT-Sp behaves differently in patients with heart ...failure compared to patients with cancer. Background The Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp) is a 12-item measure of spiritual well-being in chronic illness originally developed in patients with cancer. A 2-factor structure (meaning/peace, faith) was initially proposed for the FACIT-Sp. Subsequently, a 3-factor structure (meaning, peace, faith) was proposed, and consensus on the best factor structure has not been reached. In addition, the factor structure of the FACIT-Sp has not been considered in patients with heart failure. Research Objectives To examine the factor structure of the FACIT-Sp in patients with heart failure. Methods Exploratory factor analysis (EFA) was conducted on 217 patients with heart failure using baseline data from the CASA (Collaborative Care to Alleviate Symptoms and Adjust to Illness) trial. Two EFA extraction methods were used to address discrepancies in factor structure observed in prior research: maximum likelihood (ML; 3 factors max) and principal components analysis (PCA; eigenvalue≥1). Promax rotation was used with both methods. The resulting factors were further assessed by examining Cronbach's alpha and correlations with measures of quality of life and psychological health. Results ML suggested 3 factors (meaning, peace, faith). This was similar to the existing 3-factor model besides the very weak loading of one negatively worded item (#4) onto the peace factor (λ=0.16). PCA produced Results similar to the existing 2-factor model (meaning/peace, faith), but the two negatively worded items (#4, #8) were excluded from the meaning/peace factor and formed a new but likely not meaningful factor. Internal consistency improved after dropping negatively worded items from existing factors, and concurrent validity was acceptable. Conclusion The best factor model in heart failure patients depended on the method used. Extraction method may therefore explain discrepancies observed in prior research. The negatively worded items exhibited unexpected behavior.
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