Spiritual support in end stage heart - PowerPoint Presentation

1. Spiritual support in end stage heart failure (ESHF): a randomised controlled feasibility study Linda Ross1, Jackie Austin2,Paul Jarvis1, Sara Pickett3  1School of Care Sciences, LSE, University of South Wales 2Cardiac Rehabilitation Services, Nevill Hall Hospital, Aneurin Bevan University Health Board (ABUHB) 3Swansea Centre for Health Economics, Swansea University This study was funded by the Nevill Hall Thrombosis & General Research Fundsupport (experimental group n=22). Spiritual support (average 1 hour discussion using a purpose designed Spiritual Enquiry Tool) was provided by trained volunteers in patients’ homes at 2 monthly intervals over 6 months (4 visits). Measures of study outcomes (WHO-SRPB, HAD, EQ5D) were completed at 0, 2, 4, 6 months by both groups. AnalysisDescriptive statistics and Repeated Measures ANOVA to explore within and between group differences.  Selected Results with follow-on questions 1.No significant effect of spiritual support on spiritual wellbeing (SWB), anxiety/depression or quality of life (QOL) was found. The study was limited by its small sample sizebut the following trends were identified and are worthy of further exploration: -The control group showed a marked worsening in SWB (-1.7 points), anxiety (+0.8 points) and QOL (-8.0 points) between months 0 and 2, whilst the experimental group showed a marked improvement in QOL (+4.0 points) and anxiety (-1.2 points) at this time. Depression scores increased in experimental patients (+0.9) and decreased in control patients (-0.6) at the end of the study (months 4-6). Is there a group allocation effect? -SWB dropped by 4.8 points in patients reporting deterioration of symptoms between months 0-2, so is there a link between SWB and symptoms?2. Recruitment and data collection took much longer than expected. We had estimated that 65 patients would be recruited over 9 months with data collection taking 15 months. In reality it took 18 months to recruit 47 patients and 2 years to collect the data, mainly because of high co-morbidity and mortality. References1 Koenig H, King D, Carson V (2012) Handbook of religion and health. OUP, New York2 World Health Organisation (2002) WHOQOL-SRPB Field Test Instrument. WHO, Geneva3 Department of Health (2009) Religion or belief. A practical guide for the NHS. London, Crown4 Welsh Government (2015) Health and Care Standards. Crown5 NICE (2004) Guidance on Cancer Service. Improving supportive and palliative care for adults with cancer. London, NICE6 Ross L, Austin J (2013) Spiritual needs and support preferences of people with end stage heart failure and their carers. Journal of Nursing Management, 23, 1, 87-95Background Evidence demonstrates a positive association between the spiritual part of life and mental (anxiety, depression, quality of life) and physical health1. Spiritual care is important, featuring within healthcare policy and guidance internationally2, nationally3 and locally4, especially at end of life5. There is evidence that people with ESHF experience significant spiritual needs (e.g. for hope and to make sense of their illness, life and the future including their death and what may lie beyond) alongside the physical and emotional challenges of their illness, and that spiritual support would be valued6. Further research is needed to determine if spiritual support enhances spiritual wellbeing and quality of life and mitigates against depression and anxiety in ESHF, but information is needed to inform the design of such a study. Overall Aim To carry out a feasibility study to inform the design of a future RCT to investigate the effects of spiritual support on spiritual wellbeing, anxiety, depression and quality of life in end-stage heart failure patients (NYHA IV/V) .Research Questions:1. What is the effect of spiritual support on spiritual wellbeing (WHO-SRPB), anxiety/depression (HAD), and health related quality of life (EQ5D)?2. What is the likely effect size of the WHO SRPB Tool measuring Spiritual Wellbeing2 (to inform power calculation)?3. What is the cost of delivering the intervention (NHS Resource Use Questionnaire)?4. What is the likely uptake/drop-out rate in patients (to inform sample size and power calculations)?5. How much time is needed to deliver the intervention and to collect data? MethodProspective random allocation over 18 months of all consenting eligible end-stage heart failure patients in ABUHB (n=47 from possible 270) to receive standard care only (control group n=25) or standard care plus spiritual