Laura C Hanson1, Christine E Kistler2, Kyle Lavin3, Stacey L Gabriel4, Natalie C Ernecoff5, Feng-Chang Lin6, Greg A Sachs7, Susan L Mitchell8. 1. Division of Geriatric Medicine and Palliative Care Program, Cecil G. Sheps Center for Health Services Research, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA. Electronic address: lhanson@med.unc.edu. 2. Department of Family Medicine and Palliative Care Program, Cecil G. Sheps Center for Health Services Research, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA. 3. Department of Psychiatry and Palliative Care Program, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA. 4. Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina, USA. 5. Department of Health Policy and Management, Cecil G. Sheps Center for Health Services Research, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA. 6. Department of Biostatistics, Gillings Global School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. 7. Division of General Internal Medicine & Geriatrics, Indiana University School of Medicine, Indiana University Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana, USA. 8. Hebrew SeniorLife Institute for Aging Research and Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Abstract
CONTEXT: Persons with late-stage dementia have limited access to palliative care. OBJECTIVE: The objective of this study was to test dementia-specific specialty palliative care triggered by hospitalization. METHODS: This pilot randomized controlled trial enrolled 62 dyads of persons with late-stage dementia and family decision-makers on admission to hospital. Intervention dyads received dementia-specific specialty palliative care consultation plus postacute transitional care. Control dyads received usual care and educational information. The primary outcome was 60-day hospital or emergency department visits. Secondary patient- and family-centered outcomes were patient comfort, family distress, palliative care domains addressed in the treatment plan, and access to hospice or community-based palliative care. Secondary decision-making outcomes were discussion of prognosis, goals of care, completion of Medical Orders for Scope of Treatment (MOST), and treatment decisions. RESULTS:Of 137 eligible dyads, 62 (45%) were enrolled. The intervention proved feasible, with protocol completion ranging from 77% (family two-week call) to 93% (initial consultation). Hospital and emergency department visits did not differ (intervention vs. control, 0.68 vs. 0.53 transfers per 60 days, P = 0.415). Intervention patients had more palliative care domains addressed and were more likely to receive hospice (25% vs. 3%, P < 0.019). Intervention families were more likely to discuss prognosis (90% vs. 3%, P < 0.001) and goals of care (90% vs. 25%, P < 0.001) and to have a MOST at 60-day follow-up (79% vs. 30%, P < 0.001). More intervention families made decisions to avoid rehospitalization (13% vs. 0%, P = 0.033). CONCLUSION: Specialty palliative care consultation for hospitalized patients with late-stage dementia is feasible and promising to improve decision-making and some treatment outcomes.
RCT Entities:
CONTEXT: Persons with late-stage dementia have limited access to palliative care. OBJECTIVE: The objective of this study was to test dementia-specific specialty palliative care triggered by hospitalization. METHODS: This pilot randomized controlled trial enrolled 62 dyads of persons with late-stage dementia and family decision-makers on admission to hospital. Intervention dyads received dementia-specific specialty palliative care consultation plus postacute transitional care. Control dyads received usual care and educational information. The primary outcome was 60-day hospital or emergency department visits. Secondary patient- and family-centered outcomes were patient comfort, family distress, palliative care domains addressed in the treatment plan, and access to hospice or community-based palliative care. Secondary decision-making outcomes were discussion of prognosis, goals of care, completion of Medical Orders for Scope of Treatment (MOST), and treatment decisions. RESULTS: Of 137 eligible dyads, 62 (45%) were enrolled. The intervention proved feasible, with protocol completion ranging from 77% (family two-week call) to 93% (initial consultation). Hospital and emergency department visits did not differ (intervention vs. control, 0.68 vs. 0.53 transfers per 60 days, P = 0.415). Intervention patients had more palliative care domains addressed and were more likely to receive hospice (25% vs. 3%, P < 0.019). Intervention families were more likely to discuss prognosis (90% vs. 3%, P < 0.001) and goals of care (90% vs. 25%, P < 0.001) and to have a MOST at 60-day follow-up (79% vs. 30%, P < 0.001). More intervention families made decisions to avoid rehospitalization (13% vs. 0%, P = 0.033). CONCLUSION: Specialty palliative care consultation for hospitalized patients with late-stage dementia is feasible and promising to improve decision-making and some treatment outcomes.
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