David Casarett1, Megan Johnson, Dawn Smith, Diane Richardson. 1. Division of Geriatric Medicine, School of Medicine, University of Pennsylvania, 3615 Chestnut St, Philadelphia, PA 19104, USA. Casarett@mail.med.upenn.edu
Abstract
BACKGROUND: Growing attention to end-of-life care has led to intensive efforts to provide better palliative care. However, it is not known whether palliative care is best provided by consultative teams or in dedicated units. METHODS: This nationwide telephone survey was conducted in 77 Veterans Affairs medical centers that offer palliative care consultation services and dedicated palliative care units. One family member per patient who died at a participating Veterans Affairs medical center between July 1, 2008, and December 31, 2009, was invited to participate. The telephone survey included 1 global rating item and 9 core items describing the patient's care in the last month of life. RESULTS: Interviews were completed with family members for 5901 of 9546 patients. Of these, 1873 received usual care, 1549 received a palliative care consultation, and 2479 received care in a palliative care unit. After nonresponse weighting and propensity score adjustment, families of patients who received a palliative care consultation were more likely than those who received usual care to report that the patient's care in the last month of life had been "excellent" (adjusted proportions: 51% vs 46%; odds ratio [OR], 1.25; 95% confidence interval [CI], 1.02-1.55; P = .04). However, families of patients who received care in a palliative care unit were even more likely to report excellent care (adjusted proportions: 63% vs 53%; OR, 1.52; 95% CI, 1.25-1.85; P < .001). CONCLUSION: Care received in palliative care units may offer more improvements in care than those achieved with palliative care consultations.
BACKGROUND: Growing attention to end-of-life care has led to intensive efforts to provide better palliative care. However, it is not known whether palliative care is best provided by consultative teams or in dedicated units. METHODS: This nationwide telephone survey was conducted in 77 Veterans Affairs medical centers that offer palliative care consultation services and dedicated palliative care units. One family member per patient who died at a participating Veterans Affairs medical center between July 1, 2008, and December 31, 2009, was invited to participate. The telephone survey included 1 global rating item and 9 core items describing the patient's care in the last month of life. RESULTS: Interviews were completed with family members for 5901 of 9546 patients. Of these, 1873 received usual care, 1549 received a palliative care consultation, and 2479 received care in a palliative care unit. After nonresponse weighting and propensity score adjustment, families of patients who received a palliative care consultation were more likely than those who received usual care to report that the patient's care in the last month of life had been "excellent" (adjusted proportions: 51% vs 46%; odds ratio [OR], 1.25; 95% confidence interval [CI], 1.02-1.55; P = .04). However, families of patients who received care in a palliative care unit were even more likely to report excellent care (adjusted proportions: 63% vs 53%; OR, 1.52; 95% CI, 1.25-1.85; P < .001). CONCLUSION: Care received in palliative care units may offer more improvements in care than those achieved with palliative care consultations.
Authors: Katherine R Courtright; Vanessa Madden; Nicole B Gabler; Elizabeth Cooney; Dylan S Small; Andrea Troxel; David Casarett; Mary Ersek; J Brian Cassel; Lauren Hersch Nicholas; Gabriel Escobar; Sarah H Hill; Dan O'Brien; Mark Vogel; Scott D Halpern Journal: Ann Am Thorac Soc Date: 2016-09