The comprehensive care team: a controlled trial of outpatient palliative medicine consultation

The comprehensive care team: a controlled trial of outpatient palliative medicine consultation

Rabow MW; Dibble SL; Pantilat SZ; McPhee SJ

Archives Of Internal Medicine

2004

Female; Humans; Male; Questionnaires; Aged; California; Outcome and Process Assessment (Health Care); quality of life; Office Visits/statistics & numerical data; Advance Care Planning/statistics & numerical data; Chronic Obstructive/complications/psychology/therapy; Heart Failure/complications/psychology/therapy; Hospital/organization & administration/utilization; Neoplasms/complications/psychology/therapy; Outpatient Clinics; Palliative Care/organization & administration; patient care team; Primary Health Care/organization & administration/utilization; Pulmonary Disease

BACKGROUND: Little is known about the use of palliative care for outpatients who continue to pursue treatment of their underlying disease or whether outpatient palliative medicine consultation teams improve clinical outcomes. METHODS: We conducted a year-long controlled trial involving 50 intervention patients and 40 control patients in a general medicine outpatient clinic. Primary care physicians referred patients with advanced congestive heart failure, chronic obstructive pulmonary disease, or cancer who had a prognosis ranging from 1 to 5 years. In the intervention group, the primary care physicians received multiple palliative care team consultations, and patients received advance care planning, psychosocial support, and family caregiver training. Clinical and health care utilization outcomes were assessed at 6 and 12 months. RESULTS: Groups were similar at baseline. Similar numbers of patients died during the study year (P =.63). After the intervention, intervention group patients had less dyspnea (P =.01) and anxiety (P =.05) and improved sleep quality (P =.05) and spiritual well-being (P =.007), but no change in pain (P =.41), depression (P =.28), quality of life (P =.43), or satisfaction with care (P =.26). Few patients received recommended analgesic or antidepressant medications. Intervention patients had decreased primary care (P =.03) and urgent care visits (P =.04) without an increase in emergency department visits, specialty clinic visits, hospitalizations, or number of days in the hospital. There were no differences in charges (P =.80). CONCLUSIONS: Consultation by a palliative medicine team led to improved patient outcomes in dyspnea, anxiety, and spiritual well-being, but failed to improve pain or depression. Palliative care for seriously ill outpatients can be effective, but barriers to implementation must be explored.

2004

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