Myrick C Shinall1, Mohana Karlekar2, Sara Martin2, Cheryl L Gatto3, Sumi Misra4, Chan Y Chung5, Michael K Porayko5, Andrew E Scanga5, Natasha J Schneider5, E Wesley Ely6, Jill M Pulley3, Rebecca N Jerome3, Mary Lynn Dear3, Douglas Conway3, Reagan Buie3, Dandan Liu7, Christopher J Lindsell7, Gordon R Bernard8. 1. Section of Palliative Care, Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Critical Illness, Brain Dysfunction, and Survivorship Center, Nashville, Tennessee, USA; Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA. Electronic address: ricky.shinall@vanderbilt.edu. 2. Section of Palliative Care, Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA. 3. Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA. 4. Section of Palliative Care, Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Tennessee Valley Geriatrics Research Education and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, USA. 5. Vanderbilt Hepatology and Liver Transplant Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA. 6. Critical Illness, Brain Dysfunction, and Survivorship Center, Nashville, Tennessee, USA; Tennessee Valley Geriatrics Research Education and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, USA; Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA. 7. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA. 8. Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Abstract
CONTEXT: Palliative care interventions have shown promise in improving quality of life and reducing health-care utilization among patients with chronic organ failure. OBJECTIVES: To evaluate the effect of a palliative care intervention for adults with end-stage liver disease. METHODS: A randomized controlled trial of patients with end-stage liver disease admitted to the hepatology service at a tertiary referral center whose attending hepatologist indicated they would not be surprised if the patient died in the following year on a standardized questionnaire was performed. Control group patients received usual care. Intervention group patients received inpatient specialist palliative care consultations and outpatient phone follow-up by a palliative care nurse. The primary outcome was time until first readmission. Secondary outcomes included days alive outside the hospital, referral to hospice care, death, readmissions, patient quality of life, depression, anxiety, and quality of end-of-life care over 6 months. RESULTS: The trial stopped early because of difficulties in accruing patients. Of 293 eligible patients, only 63 patients were enrolled, 31 in the intervention group and 32 in the control group. This pace of enrollment was only 25% of what the study had planned, and so it was deemed infeasible to complete. Despite stopping early, intervention group patients had a lower hazard of readmission (hazard ratio: 0.36, 95% confidence interval: 0.16-0.83, P = 0.017) and greater odds of having more days alive outside the hospital than control group patients (odds ratio: 3.97, 95% confidence interval: 1.14-13.84, P = 0.030). No other statistically significant differences were observed. CONCLUSION: Logistical obstacles hindered completion of the trial as originally designed. Nevertheless, a preemptive palliative care intervention resulted in increased time to first readmission and more days alive outside the hospital in the first six months after study entry.
RCT Entities:
CONTEXT: Palliative care interventions have shown promise in improving quality of life and reducing health-care utilization among patients with chronic organ failure. OBJECTIVES: To evaluate the effect of a palliative care intervention for adults with end-stage liver disease. METHODS: A randomized controlled trial of patients with end-stage liver disease admitted to the hepatology service at a tertiary referral center whose attending hepatologist indicated they would not be surprised if the patient died in the following year on a standardized questionnaire was performed. Control group patients received usual care. Intervention group patients received inpatient specialist palliative care consultations and outpatient phone follow-up by a palliative care nurse. The primary outcome was time until first readmission. Secondary outcomes included days alive outside the hospital, referral to hospice care, death, readmissions, patient quality of life, depression, anxiety, and quality of end-of-life care over 6 months. RESULTS: The trial stopped early because of difficulties in accruing patients. Of 293 eligible patients, only 63 patients were enrolled, 31 in the intervention group and 32 in the control group. This pace of enrollment was only 25% of what the study had planned, and so it was deemed infeasible to complete. Despite stopping early, intervention group patients had a lower hazard of readmission (hazard ratio: 0.36, 95% confidence interval: 0.16-0.83, P = 0.017) and greater odds of having more days alive outside the hospital than control group patients (odds ratio: 3.97, 95% confidence interval: 1.14-13.84, P = 0.030). No other statistically significant differences were observed. CONCLUSION: Logistical obstacles hindered completion of the trial as originally designed. Nevertheless, a preemptive palliative care intervention resulted in increased time to first readmission and more days alive outside the hospital in the first six months after study entry.
Authors: Melisa Wilson; Rebekah H Anguiano; Rana L A Awdish; James C Coons; Amy Kimber; Melissa Morrison; Sara Paulus; Ann Schmit; Frank Spexarth; Keith M Swetz; Nathan J Verlinden; Mary E Whittenhall; Margaret R Sketch; Meredith Broderick; Jacqueline Brewer Journal: Pulm Circ Date: 2022-01-05 Impact factor: 2.886
Authors: Christopher D Woodrell; Nathan E Goldstein; Jaison R Moreno; Thomas D Schiano; Myron E Schwartz; Melissa M Garrido Journal: J Pain Symptom Manage Date: 2020-10-06 Impact factor: 3.612