{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T13:14:13Z","timestamp":1789391653950,"version":"build-2803163510"},"reference-count":47,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T00:00:00Z","timestamp":1778803200000},"content-version":"unspecified","delay-in-days":14,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Ministry of Health, National Medical Research Council, Health Services New Investigator","award":["ID-MOH-000733-00"],"award-info":[{"award-number":["ID-MOH-000733-00"]}]},{"name":"Ministry of Health, National Medical Research Council, Health Services New Investigator","award":["MOH-HNIG20nov-0003"],"award-info":[{"award-number":["MOH-HNIG20nov-0003"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,4,29]]},"published-print":{"date-parts":[[2026,5]]},"abstract":"\n Objectives<\/jats:title>\n To evaluate the feasibility, acceptability and potential efficacy of the culturally adapted Educate, Nurture, Advise Before Life Ends (ENABLE) programme in Singapore for patients with heart failure (HF) and their family caregivers.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n Non-blinded randomised wait-list controlled pilot study, using Simon\u2019s randomised phase II trial design.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n Specialist outpatient clinics in a tertiary cardiac centre in Singapore.<\/jats:p>\n <\/jats:sec>\n \n Participants<\/jats:title>\n Patients had a diagnosis of American Heart Association Stage C or D HF, were symptomatic with New York Heart Association functional class 2 and above symptoms, had a prognosis of 6 months, a hospitalisation in prior 6 months and were on disease-directed HF management. Patients already known to palliative care (PC) were excluded. Recruited caregivers were family caregivers of patients.<\/jats:p>\n <\/jats:sec>\n \n Intervention<\/jats:title>\n ENABLE integrates PC early into HF care. It starts with a comprehensive PC assessment with a PC physician and nurse. This is followed by a series of nurse coach-led health coaching sessions for both patients and caregivers. After the completion of health coaching, participants would receive follow-up phone calls to review their coping up to 6 months post-enrolment.<\/jats:p>\n <\/jats:sec>\n \n Outcome measures<\/jats:title>\n \n Feasibility<\/jats:italic>\n was defined by the proportion of approached patient-caregiver dyads who consented to participate and the proportion of participants who completed health coaching.\n Acceptability<\/jats:italic>\n was defined by a score of at least 12 out of a maximum of 16 for the Client Satisfaction Questionnaire 4-Item Survey. Primary\n efficacy<\/jats:italic>\n outcome measure was the change in patient quality of life (QOL) at 6 months as measured by Kansas City Cardiomyopathy Questionnaire (KCCQ) total score, with the target effect size (Cohen\u2019s d) being at least 0.25 SD in favour of ENABLE. Other secondary outcomes included patient\/caregiver anxiety and depression scores on the Hospital Anxiety and Depression Scale, spirituality scores on the Functional Assessment of Chronic Illness Therapy-Spiritual Wellbeing Scale and caregiver QOL on the Singapore Caregiver Quality of Life Scale.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Feasibility<\/jats:italic>\n : recruitment was carried out from February 2022 to October 2023. We approached 164 patient-caregiver dyads and 60 patient-caregiver dyads (36.6%) consented. A total of 48 patients and 44 caregivers started on health coaching, of which 44 patients (91.7%) and 43 caregivers (97.7%) completed health coaching.\n <\/jats:p>\n \n Acceptability<\/jats:italic>\n : patients\u2019 satisfaction was high, at 85.7% and 87.5% in the intervention and wait-list arm, respectively. Caregivers were similarly satisfied, at 100% and 87.5% in the two arms, respectively.\n <\/jats:p>\n \n Efficacy<\/jats:italic>\n : intervention-arm patients had a higher mean total KCCQ score at 6 months than wait-list-arm patients (difference in means=12.4; 95%\u2009CI 0.9\u2009to 24.0; Cohen\u2019s d=0.43). There was no difference in caregiver QOL changes between trial arms at 3 months and 6 months. Both patients and caregivers had improvements in anxiety at 3 months and sustained improvements in depression and spirituality at 6 months.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Proportion of participants who completed health coaching was high, though proportion of approached participants who consented was lower than expected. Our acceptability and efficacy targets were met. Further phase III testing is planned.<\/jats:p>\n <\/jats:sec>\n \n Trial registration number<\/jats:title>\n \n NCT05211882<\/jats:ext-link>\n .\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-113749","type":"journal-article","created":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T07:55:29Z","timestamp":1778918129000},"page":"e113749","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Feasibility, acceptability and efficacy of a nurse-led palliative care health coaching intervention (Educate, Nurture, Advise before Life Ends) for patients with heart failure and their caregivers in Singapore: a randomised wait-list controlled pilot study of health coaching in Asian heart failure"],"prefix":"10.1136","volume":"16","clinical-trial-number":[{"clinical-trial-number":"nct05211882","registry":"10.18810\/clinical-trials-gov","type":"results"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2811-1661","authenticated-orcid":false,"given":"Shirlyn Hui-Shan","family":"Neo","sequence":"first","affiliation":[{"name":"Division of Supportive and Palliative Care, National Cancer Centre, Singapore"},{"name":"Lien Centre for Palliative Care, Duke-NUS Graduate Medical School, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Whee Sze","family":"Ong","sequence":"additional","affiliation":[{"name":"Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kehua","family":"Liao","sequence":"additional","affiliation":[{"name":"Nursing Service, Woodlands Health, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David Kheng-Leng","family":"Sim","sequence":"additional","affiliation":[{"name":"Cardiology, National Heart Centre Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elaine Swee Ling","family":"Ng","sequence":"additional","affiliation":[{"name":"Nursing Specialty Care Unit, National Heart Centre Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cherylyn Chun-zhen","family":"Foo","sequence":"additional","affiliation":[{"name":"Division of Supportive and Palliative Care, National Cancer Centre, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace","family":"Yang Meijuan","sequence":"additional","affiliation":[{"name":"Division of Supportive and Palliative Care, National Cancer Centre, Singapore"},{"name":"Lien Centre for Palliative Care, Duke-NUS Graduate Medical School, Singapore"},{"name":"National University Singapore Saw Swee Hock School of Public Health, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J Nicholas","family":"Odom","sequence":"additional","affiliation":[{"name":"School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie","family":"Bakitas","sequence":"additional","affiliation":[{"name":"School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yin Bun","family":"Cheung","sequence":"additional","affiliation":[{"name":"Global Health Group, Tampere Universities, Tampere, Finland"},{"name":"Centre for Biomedical Data Science, Duke-NUS Medical School, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,5,15]]},"reference":[{"key":"2026051600551657000_16.5.e113749.1","unstructured":"Ministry of Health Statistics . 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