Triggered Palliative Care for Late-Stage Dementia: A Pilot Randomized Trial

Laura C. Hanson, Christine E. Kistler, Kyle Lavin, Stacey L. Gabriel, Natalie C. Ernecoff, Feng Chang Lin, Greg Sachs, Susan L. Mitchell

Research output: Contribution to journalArticle

1 Citation (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)10-19
Number of pages10
JournalJournal of Pain and Symptom Management
Volume57
Issue number1
DOIs
StatePublished - Jan 1 2019

Fingerprint

Palliative Care
Dementia
Patient Care Planning
Hospices
Referral and Consultation
Hospital Departments
Hospital Emergency Service
Decision Making
Subacute Care
Therapeutics
Hospitalization
Randomized Controlled Trials

Keywords

  • Dementia
  • palliative care
  • randomized trial

ASJC Scopus subject areas

  • Nursing(all)
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

Hanson, L. C., Kistler, C. E., Lavin, K., Gabriel, S. L., Ernecoff, N. C., Lin, F. C., ... Mitchell, S. L. (2019). Triggered Palliative Care for Late-Stage Dementia: A Pilot Randomized Trial. Journal of Pain and Symptom Management, 57(1), 10-19. https://doi.org/10.1016/j.jpainsymman.2018.10.494

Triggered Palliative Care for Late-Stage Dementia : A Pilot Randomized Trial. / Hanson, Laura C.; Kistler, Christine E.; Lavin, Kyle; Gabriel, Stacey L.; Ernecoff, Natalie C.; Lin, Feng Chang; Sachs, Greg; Mitchell, Susan L.

In: Journal of Pain and Symptom Management, Vol. 57, No. 1, 01.01.2019, p. 10-19.

Research output: Contribution to journalArticle

Hanson, LC, Kistler, CE, Lavin, K, Gabriel, SL, Ernecoff, NC, Lin, FC, Sachs, G & Mitchell, SL 2019, 'Triggered Palliative Care for Late-Stage Dementia: A Pilot Randomized Trial', Journal of Pain and Symptom Management, vol. 57, no. 1, pp. 10-19. https://doi.org/10.1016/j.jpainsymman.2018.10.494
Hanson, Laura C. ; Kistler, Christine E. ; Lavin, Kyle ; Gabriel, Stacey L. ; Ernecoff, Natalie C. ; Lin, Feng Chang ; Sachs, Greg ; Mitchell, Susan L. / Triggered Palliative Care for Late-Stage Dementia : A Pilot Randomized Trial. In: Journal of Pain and Symptom Management. 2019 ; Vol. 57, No. 1. pp. 10-19.
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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.",
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AB - 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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