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

J Pain Symptom Manage. 2019 Jan;57(1):10-19. doi: 10.1016/j.jpainsymman.2018.10.494. Epub 2018 Oct 18.

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.

Trial registration: ClinicalTrials.gov NCT02719938.

Keywords: Dementia; palliative care; randomized trial.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease / therapy
  • Aged, 80 and over
  • Decision Making
  • Dementia / complications
  • Dementia / therapy*
  • Family / psychology
  • Feasibility Studies
  • Female
  • Follow-Up Studies
  • Health Communication
  • Hospitalization*
  • Humans
  • Male
  • Palliative Care* / methods
  • Patient-Centered Care
  • Pilot Projects
  • Quality of Health Care
  • Treatment Outcome

Associated data

  • ClinicalTrials.gov/NCT02719938