Spiritual support in end stage heart failure: a randomised controlled feasibility study

Spiritual care is important, especially at end of life. People with ESHF experience spiritual needs alongside the physical/emotional challenges of their illness and would welcome spiritual support (SS). It is unclear if SS enhances spiritual wellbeing (SWB) and/or quality of life (QOL), or reduces depression/anxiety in ESHF. Information is needed to inform the design of such a study. Aims 1. To make recommendations on the feasibility/design of a follow-on RCT to investigate the effect of SS on specified outcomes in ESHF. 2. To investigate the effect of SS on SWB (WHO SRPB QOL Field Test Instrument), anxiety/depression (Hospital Anxiety and Depression Scale), and QOL (EQ-5D-3L) if the sample size is sufficient (or to identify trends if not). Method Prospective random allocation over 18 months of ESHF patients in one Health Board in Wales (n=47 from possible 133) to receive standard care only (control group n=25) or standard care plus SS (experimental group n=22); SS provided by trained volunteers in patients’ homes at 2 monthly intervals over 6 months (4 visits). Completion of study outcome measures and potential confounding factors (circumstances, life events, symptoms, medication) at 0, 2, 4, 6 months in both groups. Analysis Descriptive statistics, Repeated Measures ANOVA and standard economic analysis methods. Results Aim 1 • Poor uptake (35%), attrition and missing data compromised the ability to detect significant changes in study outcomes. • Time is needed for recruitment (18 months) and data collection (2 years); inclusion of a research nurse/administrator is recommended. • SS was valued by those receiving it. • Nurses lacked confidence in initiating end of life conversations; training is recommended. • Spiritual wellbeing was negatively correlated with anxiety (Rho ranging from -.306 to -.385, p<0.05) and depression (Rho ranging from -.342 to -.648, p<0.05) Aim 2. The following trends were noted and require further exploration: • Positive effect of SS on QOL (increase of .4 points in intervention group at 0-2 months) and anxiety (decrease of 1.2 points in intervention group at 0-2 months) but not on depression or SWB. This may be due to a group allocation effect. • Negative effect (increased depression of .9 points) of withdrawal of SS from experimental group at close of the study (months 4-6). • Lower health resource cost per experimental patient (£204) over the study period; SS may be cost effective if rolled out to more patients within routine care.