title: Feasibility and acceptability of a collaborative care intervention to improve symptoms and quality of life in chronic heart failure: mixed methods pilot trial.
abstract: BACKGROUND
  People with chronic heart failure (HF) suffer from numerous symptoms that worsen quality of life. The CASA (Collaborative Care to Alleviate Symptoms and Adjust to Illness) intervention was designed to improve symptoms and quality of life by integrating palliative and psychosocial care into chronic care.
  
  
  OBJECTIVE
  Our aim was to determine the feasibility and acceptability of CASA and identify necessary improvements.
  
  
  METHODS
  We conducted a prospective mixed-methods pilot trial. The CASA intervention included (1) nurse phone visits involving structured symptom assessments and guidelines to alleviate breathlessness, fatigue, pain, or depression; (2) structured phone counseling targeting adjustment to illness and depression if present; and (3) weekly team meetings with a palliative care specialist, cardiologist, and primary care physician focused on medical recommendations to primary care providers (PCPs, physician or nurse practioners) to improve symptoms. Study subjects were outpatients with chronic HF from a Veteran's Affairs hospital (n=15) and a university hospital (n=2). Measurements included feasibility (cohort retention rate, medical recommendation implementation rate, missing data, quality of care) and acceptability (an end-of-study semi-structured participant interview).
  
  
  RESULTS
  Participants were male with a median age of 63 years. One withdrew early and there were <5% missing data. Overall, 85% of 87 collaborative care team medical recommendations were implemented. All participants who screened positive for depression were either treated for depression or thought to not have a depressive disorder. In the qualitative interviews, patients reported a positive experience and provided several constructive critiques.
  
  
  CONCLUSIONS
  The CASA intervention was feasible based on participant enrollment, cohort retention, implementation of medical recommendations, minimal missing data, and acceptability. Several intervention changes were made based on participant feedback.
authors: 1 Eastern Colorado Health Care System , Department of Veterans Affairs, Denver, Colorado.
authors: David B
authors: DB
authors: Bekelman
authors: Stephanie
authors: S
authors: Hooker
authors: Carolyn T
authors: CT
authors: Nowels
authors: Deborah S
authors: DS
authors: Main
authors: Paula
authors: P
authors: Meek
authors: Connor
authors: C
authors: McBryde
authors: Brack
authors: B
authors: Hattler
authors: Karl A
authors: KA
authors: Lorenz
authors: Paul A
authors: PA
authors: Heidenreich
mesh_terms: D002908:Chronic Disease; D003376:Counseling; D003863:Depression / Q000453:epidemiology / Q000523:psychology; D005240:Feasibility Studies; D006333:Heart Failure / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D006785:Hospitals, University; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D010348:Patient Care Team / Q000458:organization & administration*; D010865:Pilot Projects; D011446:Prospective Studies; D011788:Quality of Life; D013689:Telephone; D014481:United States / Q000453:epidemiology