Delivery strategies to optimize resource utilization and performance status for patients with advanced life-limiting illness: Results from the "palliative care trial" [ISRCTN 81117481]

Abernethy, AP; Currow, DC; Shelby-James, T; Rowett, D; May, F; Samsa, GP; Hunt, R; Williams, H; Esterman, A; Phillips, PA

Delivery strategies to optimize resource utilization and performance status for patients with advanced life-limiting illness: Results from the "palliative care trial" [ISRCTN 81117481]

Abernethy, AP Currow, DC

Shelby-James, T Rowett, D May, F Samsa, GP Hunt, R Williams, H Esterman, A Phillips, PA

Permalink

Publication Type:: Journal Article
Citation:: Journal of Pain and Symptom Management, 2013, 45 (3), pp. 488 - 505
Issue Date:: 2013-03-01

Closed Access

	Filename	Description	Size
	1-s2.0-S0885392412002746-main.pdf	Published Version	368.76 kB	Adobe PDF	View/Open

Copyright Clearance Process

Recently Added
In Progress
Closed Access

This item is closed access and not available.

Full metadata record

Field	Value	Language
dc.contributor.author	Abernethy, AP	en_US
dc.contributor.author	Currow, DC https://orcid.org/0000-0003-1988-1250	en_US
dc.contributor.author	Shelby-James, T	en_US
dc.contributor.author	Rowett, D	en_US
dc.contributor.author	May, F	en_US
dc.contributor.author	Samsa, GP	en_US
dc.contributor.author	Hunt, R	en_US
dc.contributor.author	Williams, H	en_US
dc.contributor.author	Esterman, A	en_US
dc.contributor.author	Phillips, PA	en_US
dc.date.available	2012-02-28	en_US
dc.date.issued	2013-03-01	en_US
dc.identifier.citation	Journal of Pain and Symptom Management, 2013, 45 (3), pp. 488 - 505	en_US
dc.identifier.issn	0885-3924	en_US
dc.identifier.uri	http://hdl.handle.net/10453/117418
dc.description.abstract	Context: Evidence-based approaches are needed to improve the delivery of specialized palliative care. Objectives: The aim of this trial was to improve on current models of service provision. Methods: This 2 × 2 × 2 factorial cluster randomized controlled trial was conducted at an Australian community-based palliative care service, allowing three simultaneous comparative effectiveness studies. Participating patients were newly referred adults, experiencing pain, and who were expected to live >48 hours. Patients enrolled with their general practitioners (GPs) and were randomized three times: 1) individualized interdisciplinary case conference including their GP vs. control, 2) educational outreach visiting for GPs about pain management vs. control, and 3) structured educational visiting for patients/caregivers about pain management vs. control. The control condition was current palliative care. Outcomes included Australia-modified Karnofsky Performance Status (AKPS) and pain from 60 days after randomization and hospitalizations. Results: There were 461 participants: mean age 71 years, 50% male, 91% with cancer, median survival 179 days, and median baseline AKPS 60. Only 47% of individuals randomized to the case conferencing intervention received it; based on a priori-defined analyses, 32% of participants were included in final analyses. Case conferencing reduced hospitalizations by 26% (least squares means hospitalizations per patient: case conference 1.26 [SE 0.10] vs. control 1.70 [SE 0.13], P = 0.0069) and better maintained performance status (AKPS case conferences 57.3 [SE 1.5] vs. control 51.7 [SE 2.3], P = 0.0368). Among patients with declining function (AKPS <70), case conferencing and patient/caregiver education better maintained performance status (AKPS case conferences 55.0 [SE 2.1] vs. control 46.5 [SE 2.9], P = 0.0143; patient/caregiver education 54.7 [SE 2.8] vs. control 46.8 [SE 2.1], P = 0.0206). Pain was unchanged. GP education did not change outcomes. Conclusion: A single case conference added to current specialized community-based palliative care reduced hospitalizations and better maintained performance status. Comparatively, patient/caregiver education was less effective; GP education was not effective. © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.	en_US
dc.relation.ispartof	Journal of Pain and Symptom Management	en_US
dc.relation.isbasedon	10.1016/j.jpainsymman.2012.02.024	en_US
dc.subject.classification	Anesthesiology	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Chronic Disease	en_US
dc.subject.mesh	Pain Measurement	en_US
dc.subject.mesh	Treatment Outcome	en_US
dc.subject.mesh	Palliative Care	en_US
dc.subject.mesh	Terminal Care	en_US
dc.subject.mesh	Prevalence	en_US
dc.subject.mesh	Survival Rate	en_US
dc.subject.mesh	Risk Assessment	en_US
dc.subject.mesh	Survival Analysis	en_US
dc.subject.mesh	Comorbidity	en_US
dc.subject.mesh	Health Care Rationing	en_US
dc.subject.mesh	Aged	en_US
dc.subject.mesh	Utilization Review	en_US
dc.subject.mesh	Australia	en_US
dc.subject.mesh	Chronic Pain	en_US
dc.subject.mesh	Female	en_US
dc.subject.mesh	Male	en_US
dc.title	Delivery strategies to optimize resource utilization and performance status for patients with advanced life-limiting illness: Results from the "palliative care trial" [ISRCTN 81117481]	en_US
dc.type	Journal Article
utslib.citation.volume	3	en_US
utslib.citation.volume	45	en_US
utslib.for	1110 Nursing	en_US
utslib.for	11 Medical and Health Sciences	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/IMPACCT
utslib.copyright.status	closed_access
pubs.issue	3	en_US
pubs.publication-status	Published	en_US
pubs.volume	45	en_US

Abstract:

Context: Evidence-based approaches are needed to improve the delivery of specialized palliative care. Objectives: The aim of this trial was to improve on current models of service provision. Methods: This 2 × 2 × 2 factorial cluster randomized controlled trial was conducted at an Australian community-based palliative care service, allowing three simultaneous comparative effectiveness studies. Participating patients were newly referred adults, experiencing pain, and who were expected to live >48 hours. Patients enrolled with their general practitioners (GPs) and were randomized three times: 1) individualized interdisciplinary case conference including their GP vs. control, 2) educational outreach visiting for GPs about pain management vs. control, and 3) structured educational visiting for patients/caregivers about pain management vs. control. The control condition was current palliative care. Outcomes included Australia-modified Karnofsky Performance Status (AKPS) and pain from 60 days after randomization and hospitalizations. Results: There were 461 participants: mean age 71 years, 50% male, 91% with cancer, median survival 179 days, and median baseline AKPS 60. Only 47% of individuals randomized to the case conferencing intervention received it; based on a priori-defined analyses, 32% of participants were included in final analyses. Case conferencing reduced hospitalizations by 26% (least squares means hospitalizations per patient: case conference 1.26 [SE 0.10] vs. control 1.70 [SE 0.13], P = 0.0069) and better maintained performance status (AKPS case conferences 57.3 [SE 1.5] vs. control 51.7 [SE 2.3], P = 0.0368). Among patients with declining function (AKPS <70), case conferencing and patient/caregiver education better maintained performance status (AKPS case conferences 55.0 [SE 2.1] vs. control 46.5 [SE 2.9], P = 0.0143; patient/caregiver education 54.7 [SE 2.8] vs. control 46.8 [SE 2.1], P = 0.0206). Pain was unchanged. GP education did not change outcomes. Conclusion: A single case conference added to current specialized community-based palliative care reduced hospitalizations and better maintained performance status. Comparatively, patient/caregiver education was less effective; GP education was not effective. © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Please use this identifier to cite or link to this item:

http://hdl.handle.net/10453/117418