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 A. Sachs, Susan L. Mitchell

Research output: Contribution to journalArticle

5 Scopus citations

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 2019

Keywords

  • Dementia
  • palliative care
  • randomized trial

ASJC Scopus subject areas

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

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    Hanson, L. C., Kistler, C. E., Lavin, K., Gabriel, S. L., Ernecoff, N. C., Lin, F. C., Sachs, G. A., & 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