Feasibility and acceptability of a rural palliative care intervention for patients with heart failure (RuPAL-HF)

BACKGROUND: People with heart failure (HF) have unmet palliative care (PC) needs, particularly in rural areas. Collaborative care models may meet these needs by connecting primary care teams with urban palliative care specialists. We aimed to evaluate the feasibility and acceptability of the Rural Palliative Care for Patients with Heart Failure (RuPAL-HF) intervention. METHODS: We recruited patients with HF from a rural Maine primary care clinic. A complex care team embedded in primary care was trained in PC. Specialty PC clinicians supported the team through weekly collaborative care meetings, providing coaching and case-specific guidance. Specialty palliative care clinicians also provided tele-PC when needed. Feasibility was assessed via recruitment, referral-to-completion rates, completion of advance care planning and surveys as well as collaborative care meeting attendance. Acceptability was assessed using qualitative methods through semi-structured interviews with patients, clinicians, and complex care team members. RESULTS: The intervention was feasible and acceptable to patients, clinicians, and complex care team members. 31 patients were approached, 13 enrolled, and 12 (92.3%) completed all intervention components. All patients completed a serious illness conversation with the complex care team and 11 (84.6%) with the specialty PC physician. 12 patients (92.3%) completed an advance directive and 8 (61.5%) a Portable Medical Orders Form. Patients reported that goals-of-care conversations were not overly emotionally challenging, and they valued the telehealth option. All care team members attended trainings, completed surveys, and participated in ≥90% of collaborative care meetings. Complex care team members reported increased confidence and skills after trainings. CONCLUSION: The RuPAL-HF intervention was feasible and acceptable for patients, clinicians, and complex care team members. Telehealth appeared feasible as a mechanism to support access to specialty PC. Further research is needed to evaluate this intervention in other rural sites, care teams, and health conditions.