title: The palliative care in heart failure trial: rationale and design.
abstract: BACKGROUND
  The progressive nature of heart failure (HF) coupled with high mortality and poor quality of life mandates greater attention to palliative care as a routine component of advanced HF management. Limited evidence exists from randomized, controlled trials supporting the use of interdisciplinary palliative care in HF.
  
  
  METHODS
  PAL-HF is a prospective, controlled, unblinded, single-center study of an interdisciplinary palliative care intervention in 200 patients with advanced HF estimated to have a high likelihood of mortality or rehospitalization in the ensuing 6 months. The 6-month PAL-HF intervention focuses on physical and psychosocial symptom relief, attention to spiritual concerns, and advanced care planning. The primary end point is health-related quality of life measured by the Kansas City Cardiomyopathy Questionnaire and the Functional Assessment of Chronic Illness Therapy with Palliative Care Subscale score at 6 months. Secondary end points include changes in anxiety/depression, spiritual well-being, caregiver satisfaction, cost and resource utilization, and a composite of death, HF hospitalization, and quality of life.
  
  
  CONCLUSIONS
  PAL-HF is a randomized, controlled clinical trial that will help evaluate the efficacy and cost effectiveness of palliative care in advanced HF using a patient-centered outcome as well as clinical and economic end points.
authors.affiliation: Division of Cardiology, Duke University Medical Center, Durham, NC. Electronic address: Robert.mentz@duke.edu.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Mentz
authors.affiliation: Division of General Medicine (Palliative Medicine Section), Duke University Medical Center, Durham, NC.
authors.forename: James A
authors.initials: JA
authors.lastname: Tulsky
authors.affiliation: Duke University School of Nursing, Duke University Medical Center, Durham, NC.
authors.forename: Bradi B
authors.initials: BB
authors.lastname: Granger
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Anstrom
authors.affiliation: Division of Cardiology, Duke University Medical Center, Durham, NC.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Adams
authors.affiliation: Division of General Medicine (Palliative Medicine Section), Duke University Medical Center, Durham, NC.
authors.forename: Gwen C
authors.initials: GC
authors.lastname: Dodson
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Mona
authors.initials: M
authors.lastname: Fiuzat
authors.affiliation: Division of General Medicine (Palliative Medicine Section), Duke University Medical Center, Durham, NC.
authors.forename: Kimberly S
authors.initials: KS
authors.lastname: Johnson
authors.affiliation: Division of Cardiology, Duke University Medical Center, Durham, NC.
authors.forename: Chetan B
authors.initials: CB
authors.lastname: Patel
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, NC; Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC.
authors.forename: Karen E
authors.initials: KE
authors.lastname: Steinhauser
authors.affiliation: Duke Sanford School of Public Policy, Durham, NC.
authors.forename: Donald H
authors.initials: DH
authors.lastname: Taylor
authors.affiliation: Division of Cardiology, Duke University Medical Center, Durham, NC.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
authors.affiliation: Division of Cardiology, Duke University Medical Center, Durham, NC.
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Rogers
mesh_terms: D032722:Advance Care Planning; D003362:Cost-Benefit Analysis; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D010166:Palliative Care / Q000191:economics / Q000379:methods*; D011788:Quality of Life; D012720:Severity of Illness Index; D029181:Spirituality; D016896:Treatment Outcome