Tele-Palliative Care Intervention for Patients With Chronic Graft-Versus-Host Disease
Overview
- Phase
- N/A
- Intervention
- Tele-palliative care visit
- Conditions
- Chronic Graft-versus-host Disease
- Sponsor
- Massachusetts General Hospital
- Enrollment
- 10
- Locations
- 2
- Primary Endpoint
- Feasibility of the tele-palliative care intervention as measured by the proportion of enrolled participants who complete at least two of the three intervention visits
- Status
- Active, Not Recruiting
- Last Updated
- 26 days ago
Overview
Brief Summary
This research study is evaluating the feasibility and acceptability of implementing a telehealth palliative care intervention in patients with moderate to severe chronic graft-versus-host disease.
Detailed Description
Chronic graft-versus-host disease (cGVHD) is a major cause of morbidity among survivors of allogeneic hematopoietic cell transplantation (HCT) patients. Allogeneic HCT is a potentially curative procedure for a variety of hematologic malignancies and involves infusion of donor cells to establish marrow and immune function. Recent advances in risk determination, treatment (i.e., improved safety, use of a variety of donors), prevention of complications, and reduced-toxicity regimens have expanded the eligible patient population, and increased survival of patients who undergo HCT. However, development of cGVHD is a leading complication of allogenic HCT and impacts over 50% of survivors. It develops 3-18 months post-allogeneic HCT and is a main cause of post-HCT morbidity and mortality. cGVHD is a debilitating immunologic syndrome which attacks different organs in the body, resulting in a wide range of disruptive and unpredictable symptoms. Additionally, side effects of cGVHD include psychological distress with many patients reporting clinical levels of depression and anxiety. Further, patients with cGVHD are also at high risk for late effects, such as skeletal complications, secondary cancers, cardiovascular disease, and thromboembolic events. As a result of this diverse symptom burden, the side effects and psychological distress from illness, and uncertainty of the illness course, patients living with cGVHD experience diminished QOL. Patients with cGVHD struggle to manage their chronic condition, exacerbated with treatment related side effects of physical symptoms, functional limitations, psychological distress, and impaired QOL. Specialty palliative care clinicians have expertise in complex symptom management, facilitate coping with illness and improvement of QOL in cancer patients. Telehealth in various forms has been long studied as an approach to increase access to care, and a care model for management of chronic diseases. Expanding on prior experience with the specialty palliative care model for HCT patients, the investigators aim to develop a telehealth specialty PC model for patients with moderate to severe cGVHD. In this single-arm pilot study, the investigators will test the feasibility and acceptability of a once a month tele-palliative care appointment over the course of 3 months to address the symptom burden, psychological distress and disease uncertainty of cGVHD patients.
Investigators
El-Jawahri, Areej,M.D.
Associate Professor of Medicine
Massachusetts General Hospital
Eligibility Criteria
Inclusion Criteria
- •1\) Adult patients (\>18 years)
- •2\) Have moderate to severe cGVHD based on their oncology clinician assessment as documented in the electronic health record.
- •3\) Ability to comprehend and speak English, and to read and respond to questions in English
- •Please note that this is a proof-of-concept study, and we only include patients who comprehend, read, and respond to questions in English since the study instruments are all available in English. However, as we have done in prior studies, we will expand the population in a future efficacy trial.
Exclusion Criteria
- •1\) Patients with acute or unstable psychiatric or cognitive conditions which the treating clinicians believe prohibits informed consent or compliance with study procedures
- •2\) Patients who have already consulted or are currently consulting palliative care
Arms & Interventions
Tele-PC Intervention
Participants (individuals with moderate to severe chronic Graft-versus-Host Disease) will receive a monthly at home consultation with a specialty palliative care clinician via a video-conference tele-health visit.
Intervention: Tele-palliative care visit
Outcomes
Primary Outcomes
Feasibility of the tele-palliative care intervention as measured by the proportion of enrolled participants who complete at least two of the three intervention visits
Time Frame: Week 12
To calculate the feasibility of the intervention using the proportion of enrolled participants who complete at least two of the three intervention visits, with 95% confidence interval. The intervention will be deemed feasible if at least 70% of participants attend at least two of the three intervention visits.
Feasibility of the tele-palliative care intervention as measured by the proportion of eligible patients who are approached and agree to participate
Time Frame: Week 12
To calculate the feasibility of the intervention using the proportion of eligible patients who are approached and agree to participate, with 95% confidence interval. The intervention will be deemed feasible if at least 60% of patients with moderate to severe cGVHD agree to participate in the study.
Secondary Outcomes
- Acceptability of the tele-palliative care intervention as measured by the Client Satisfaction Questionnaire(Week 12)