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NCT02713347: ADAPT

Advancing Symptom Alleviation With Palliative Treatment

Completed NA Results posted Last updated 9 August 2024
What this trial tests

NA trial testing ADAPT Intervention in Heart Failure in 306 participants. Completed in 31 December 2021.

Timeline
1 September 2016
Primary endpoint
31 December 2020
31 December 2021

Quick facts

Lead sponsorVA Office of Research and Development
PhaseNA
StatusCompleted
Study typeINTERVENTIONAL
Allocationrandomized
Designparallel
Maskingdouble
Primary purposehealth services research
Enrollment306
Start date1 September 2016
Primary completion31 December 2020
Estimated completion31 December 2021
Sites2 locations across United States

Drugs / interventions tested

Conditions studied

Sponsor

VA Office of Research and Development — full company profile →

Who can join

Adults 18 to 99, any sex, with Heart Failure or Pulmonary Disease, Chronic Obstructive. Patients with the condition only — healthy volunteers not accepted.

Results — posted to ClinicalTrials.gov

Per-arm endpoint measurements with 95% confidence intervals where reported. Source: trial results section.

Function Assessment of Chronic Illness Therapy-General (FACT-G) Primary · 6 months

The FACT-G is a widely used, valid, reliable, and responsive self-report measure of health-related quality of life that includes domains of physical, social/family, emotional, and functional well-being. The primary outcome will be the difference in FACT-G score at 6 months. The total score range is 0-108 with a higher score meaning greater quality of life.

GroupValue95% CI
ADAPT Intervention59.0± 4.0
Enhanced Usual Care54.0± 4.0
General Symptom Distress Scale (GSDS) Secondary · 6 months

The General Symptom Distress Scale (GSDS) is a single item measure of overall symptom distress that is reliable and valid and asks, "In general, how distressing are all of your symptoms to you?" Minimum value 0 Maximum value 10 Higher scores mean more distress

GroupValue95% CI
ADAPT Intervention5.56± 0.64
Enhanced Usual Care6.0± 0.64
Patient Health Questionnaire-8 (PHQ-8) Secondary · 6 months

The PHQ-8 is a 8-item valid and reliable instrument that provides a continuous measure of depressive symptoms and is 88% sensitive and specific for a diagnosis of major depressive disorder. The PHQ-8 was developed in medically-ill outpatients. Score range 0-24 points with a higher score indicating more depressive symptoms.

GroupValue95% CI
ADAPT Intervention10.02± 1.43
Enhanced Usual Care11.58± 1.42
Kansas City Cardiomyopathy Questionnaire- Short Form (KCCQ-SF) Secondary · 6 months

The KCCQ-SF is a self-administered questionnaire that measures heart failure-specific health status. The KCCQ-SF is reliable, sensitive to clinical change, and predicts hospitalization and mortality. The KCCQ-SF will be administered to participants with heart failure. Score range 0-100 and higher scores indicate better health status.

GroupValue95% CI
ADAPT Intervention47.6± 3.47
Enhanced Usual Care43.05± 3.52
Clinical COPD Questionnaire (CCQ) Secondary · 6 months

The CCQ is a self-administered 10-item measure of COPD symptoms, functioning, and emotional well-being. It is well-validated, reliable, and responsive and will be administered to participants with COPD. Score range 0-6 with higher scores indicate worse health status.

GroupValue95% CI
ADAPT Intervention3.08± 0.1
Enhanced Usual Care3.21± 0.1
Quality of Life at the End of Life (QUAL-EC) Secondary · 6 months

The QUAL-EC is a valid and reliable self-report measure of several domains, each scored separately, of quality of life in advanced illness. Each item is rated from 1 to 5, and mean scores for multiple items in a domain, i.e., subscale were estimated. Minimum score for each subscale is 1, maximum is 5. A higher score is a better perception of quality of life for each subscale.

QUAL-E: Life Completion
GroupValue95% CI
ADAPT Intervention3.01± 0.23
Enhanced Usual Care2.88± 0.23
QUAL-E: Relationship With Healthcare Provider
GroupValue95% CI
ADAPT Intervention3.05± 0.22
Enhanced Usual Care2.87± 0.22
QUAL-E: Preparation
GroupValue95% CI
ADAPT Intervention3.86± 0.22
Enhanced Usual Care3.55± 0.22
QUAL-E: Feel At Peace
GroupValue95% CI
ADAPT Intervention3.35± 0.29
Enhanced Usual Care3.18± 0.29
Advance Care Planning Communication and Documentation Secondary · 6 months

Advance care planning discussions and advance directive documentation in the electronic medical record will be assessed via electronic medical record review. An advance directive includes either a living will and/or durable power of attorney for health care.

Documented Advance Care Planning Discussion
GroupValue95% CI
ADAPT Intervention106
Enhanced Usual Care5
Documented Advance Directive
GroupValue95% CI
ADAPT Intervention58
Enhanced Usual Care62
Mortality Secondary · 12 months

The following events will be assessed during the study period through medical record review to supplement patient report: mortality.

GroupValue95% CI
ADAPT Intervention6
Enhanced Usual Care5
Generalized Anxiety Disorder Scale (GAD-7) Secondary · 6 months

The GAD-7 is a valid and reliable self-report measure of anxiety tested in medically ill outpatient populations. Score range 0-21 and higher scores indicate more anxiety symptoms.

GroupValue95% CI
ADAPT Intervention5.82± 1.43
Enhanced Usual Care6.92± 1.42
Advance Care Planning Engagement Secondary · 6 months

This survey was designed to measure behaviors related to surrogate decision makers, values and quality of life, and informed decision making. Specifically, the Advance Care Planning-4 (ACP-4) measure (Sudore et al) was used. Minimum value is 1, maximum value is 5. Higher scores indicate higher levels of readiness to engage in advance care planning.

GroupValue95% CI
ADAPT Intervention4.21± 0.34
Enhanced Usual Care3.68± 0.34
PEG (Pain) Secondary · 6 months

The PEG measures pain intensity and interference (Krebs, 2009). Scale range 0-10 and higher score indicates more pain.

GroupValue95% CI
ADAPT Intervention4.76± 0.72
Enhanced Usual Care5.04± 0.72
Insomnia Severity Index (ISI) Secondary · 6 months

The ISI measures insomnia severity (Bastien, 2000). There are 6 items and a mean was used. Minimum score is 0, maximum score is 4. A higher score indicates more severe insomnia.

GroupValue95% CI
ADAPT Intervention2.11± 0.26
Enhanced Usual Care2.26± 0.26

Adverse events — posted to ClinicalTrials.gov

Time frame: Adverse event reporting is reported from the time participants were randomized until 6-months (for hospitalizations and all other adverse events) and 12-months (for mortality).. Reporting threshold: 0%. Adverse-event reports describe events observed during the trial — not all are caused by the drug.

ADAPT Intervention
Serious: 39/154 (25%)
Deaths: 6/154
Enhanced Usual Care
Serious: 31/152 (20%)
Deaths: 5/152

Serious adverse events (2 terms)

ReactionSystemADAPT InterventionEnhanced Usual Care
HospitalizationGeneral disorders
MortalityGeneral disorders
Other adverse events (1 terms — click to expand)

ReactionSystemADAPT InterventionEnhanced Usual Care
All other AEs (not SAE)General disorders

Most-reported serious reactions: Hospitalization, Mortality.

Data from ClinicalTrials.gov NCT02713347 adverse events section.

Sponsor's own description

Chronic heart failure (CHF), chronic obstructive pulmonary disease (COPD), and interstitial lung disease (i.e., pulmonary fibrosis) are common serious illnesses. Despite disease-specific medical care, people with these illnesses often left with poor quality of life (i.e., burdensome symptoms, impaired function). Furthermore, while these illnesses are leading causes of hospitalization and mortality, few people with these illnesses engage in advance care planning, the process of considering and communicating healthcare values and goals. The investigators are conducting a randomized clinical trial to study a symptom management, psychosocial care and advance care planning intervention to improve quality of life. The study is important because it aims to improve quality of life and provision of care according to peoples' goals and preferences in common, burdensome illnesses. Furthermore, this study will generate information that supports the broader dissemination and implementation of the intervention and informs the development of future palliative care and team-based interventions in the VA.

Publications & conference data

8 peer-reviewed publications reference this trial (live from Europe PMC):

  1. Nurse and Social Worker Palliative Telecare Team and Quality of Life in Patients With COPD, Heart Failure, or Interstitial Lung Disease: The ADAPT Randomized Clinical Trial.
    Bekelman DB, Feser W, Morgan B, Welsh CH, et al · · 2024 · cited 56× · PMID 38227034 · DOI 10.1001/jama.2023.24035
  2. Advance care planning for adults with heart failure.
    Nishikawa Y, Hiroyama N, Fukahori H, Ota E, et al · · 2020 · cited 30× · PMID 32104908 · DOI 10.1002/14651858.cd013022.pub2
  3. Advancing Symptom Alleviation with Palliative Treatment (ADAPT) trial to improve quality of life: a study protocol for a randomized clinical trial.
    Graney BA, Au DH, Barón AE, Cheng A, et al · · 2019 · cited 21× · PMID 31196156 · DOI 10.1186/s13063-019-3417-1
  4. Do goals of care documentation reflect the conversation?: Evaluating conversation-documentation accuracy.
    Ma JE, Schlichte L, Haverfield M, Gambino J, et al · · 2024 · cited 10× · PMID 38593240 · DOI 10.1111/jgs.18913
  5. Serious Illness Communication in a Randomized Trial of a Nurse and Social Worker Palliative Telecare Team.
    Lange AV, Feser WJ, Hess E, Barón AE, et al · · 2025 · cited 4× · PMID 40119839 · DOI 10.1111/jgs.19445
  6. Goal Concordance in the Advancing Symptom Alleviation with Palliative Treatment Clinical Trial of a Nurse and Social Worker Palliative Telecare Team Intervention.
    Lange AV, Hess E, Barón AE, Paden G, et al · · 2026 · PMID 42025450 · DOI 10.1177/10966218261444977
  7. <i>Letter:</i> Measuring Goal Concordance Using a Likert Scale in the ADAPT Clinical Trial.
    Lange AV, Hess E, Barón AE, Paden G, et al · · 2026 · PMID 41805425 · DOI 10.1177/10966218251392374
  8. Does Cognitive Function Influence the Benefits of Multicomponent Team Interventions?
    Lange AV, Glickman A, Wells K, Mee TC, et al · · 2026 · PMID 41205997 · DOI 10.1016/j.jamda.2025.105976

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Other recruiting trials for Heart Failure

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