Triggered Palliative Care for Late-Stage Dementia: A Pilot Randomized Trial
| Autor: | Stacey L. Gabriel, Natalie C. Ernecoff, Kyle Lavin, Laura C. Hanson, Susan L. Mitchell, Christine E. Kistler, Feng-Chang Lin, Greg A. Sachs |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Palliative care Decision Making Specialty Pilot Projects Context (language use) Article law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Patient-Centered Care Intervention (counseling) medicine Humans Dementia Family Transitional care 030212 general & internal medicine General Nursing Quality of Health Care Aged 80 and over business.industry Palliative Care Emergency department medicine.disease Hospitalization Treatment Outcome Anesthesiology and Pain Medicine Health Communication 030220 oncology & carcinogenesis Family medicine Acute Disease Feasibility Studies Female Neurology (clinical) business Follow-Up Studies |
| Zdroj: | Journal of Pain and Symptom Management. 57:10-19 |
| ISSN: | 0885-3924 |
| Popis: | CONTEXT: Persons with late-stage dementia have limited access to palliative care. OBJECTIVE: 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 post-acute 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%) enrolled. The intervention proved feasible, with protocol completion ranging from 77% (family 2-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 |
| Databáze: | OpenAIRE |
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