Dataset Information

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

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.

SUBMITTER: Hanson LC

PROVIDER: S-EPMC6310628 | biostudies-literature | 2019 Jan

REPOSITORIES: biostudies-literature

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Publications

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

Hanson Laura C LC Kistler Christine E CE Lavin Kyle K Gabriel Stacey L SL Ernecoff Natalie C NC Lin Feng-Chang FC Sachs Greg A GA Mitchell Susan L SL

Journal of pain and symptom management 20181018 1

<h4>Context</h4>Persons with late-stage dementia have limited access to palliative care.<h4>Objective</h4>The objective of this study was to test dementia-specific specialty palliative care triggered by hospitalization.<h4>Methods</h4>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. ...[more]

PMID: 30342242

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Dataset Information

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

Context

Objective

Methods

Results

Conclusion

Publications

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

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