Palliative care consultation teams in long-term care: a descriptive retrospective cohort study

Given the wide prevalence of advanced illness and frailty among residents in long-term care (LTC), a palliative approach to care can support comfort and quality of life. Yet, significant gaps exist with the provision of palliative care in LTC settings. We aim to describe a palliative care consultation team designed to address this need.

A single-centre retrospective cohort study was conducted at a LTC home in Toronto, Ontario, Canada. We included residents referred to the palliative care consultation team between February 1, 2021, to February 1, 2023, with at least six-months of follow-up time. We used a descriptive quantitative approach to examine access to the palliative care consultation team, changes to advance care plans, and hospital transfers.

Eighty-seven residents were referred and seen by the palliative care consultation team. The mean age was 85 years, 71.3% were female, and 48.3% had three to four comorbidities. Most residents were seen once (55.2%). Among residents that died (n = 53), 41.5% were referred with greater than three months of survival time. Among residents that had advance care plans documenting "Transfer to Hospital" (n = 41) and "Full Code" status (n = 17), 53.7% adjusted to "Do Not Transfer" and 76.5% to "Do Not Resuscitate" orders, respectively. The hospitalisation rate was one per 1000 resident-year.

At this LTC home, palliative care consultation teams represented an important service to improve the provision of palliative care particularly around facilitating advance care planning discussions. The findings of this study may inform further research on palliative care interventions for LTC residents.