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Triggered Palliative Care for Late-Stage Dementia: A Pilot Randomized Trial
Laura C Hanson1, Christine E Kistler2, Kyle Lavin3
1Division of Geriatric Medicine and Palliative Care Program, Cecil G. Sheps Center for Health Services Research, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA.
Journal of Pain and Symptom Management
|October 21, 2018
Summary
Specialty palliative care improves decision-making for hospitalized dementia patients. Families discussed prognosis and goals of care more, and were more likely to choose hospice.
Area of Science:
- Gerontology
- Palliative Care
- Dementia Care
Background:
- Limited access to palliative care for individuals with late-stage dementia.
- Need for specialized interventions to improve care quality during hospitalization.
Purpose of the Study:
- To evaluate dementia-specific specialty palliative care triggered by hospitalization.
- Assess feasibility and impact on patient and family outcomes.
Main Methods:
- Pilot randomized controlled trial with 62 dyads (late-stage dementia patients and family decision-makers).
- Intervention: specialty palliative care consultation + transitional care.
- Control: usual care + educational information.
Main Results:
- Intervention improved palliative care domains addressed and hospice utilization (25% vs. 3%).
- Families in the intervention group more frequently discussed prognosis (90% vs. 3%) and goals of care (90% vs. 25%).
- More intervention families completed Medical Orders for Scope of Treatment (MOST) (79% vs. 30%) and avoided rehospitalization (13% vs. 0%).
Conclusions:
- Dementia-specific specialty palliative care consultation is feasible for hospitalized patients.
- The intervention shows promise in enhancing decision-making and treatment outcomes.
- Further research is warranted to confirm these findings in larger trials.
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