Do family meetings for hospitalised palliative care patients improve outcomes and reduce health care costs? A cluster randomised trial.

Hudson, P; Girgis, A; Thomas, K; Philip, J; Currow, DC; Mitchell, G; Parker, D; Liew, D; Brand, C; Le, B; Moran, J

Do family meetings for hospitalised palliative care patients improve outcomes and reduce health care costs? A cluster randomised trial.

Hudson, P Girgis, A Thomas, K Philip, J Currow, DC Mitchell, G Parker, D

Liew, D Brand, C Le, B Moran, J

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Publisher:: SAGE PUBLICATIONS LTD
Publication Type:: Journal Article
Citation:: Palliative medicine, 2021, 35, (1), pp. 188-199
Issue Date:: 2021-01-01

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Field	Value	Language
dc.contributor.author	Hudson, P
dc.contributor.author	Girgis, A
dc.contributor.author	Thomas, K
dc.contributor.author	Philip, J
dc.contributor.author	Currow, DC
dc.contributor.author	Mitchell, G
dc.contributor.author	Parker, D https://orcid.org/0000-0003-2552-8613
dc.contributor.author	Liew, D
dc.contributor.author	Brand, C
dc.contributor.author	Le, B
dc.contributor.author	Moran, J
dc.date.accessioned	2021-09-16T05:32:19Z
dc.date.available	2021-09-16T05:32:19Z
dc.date.issued	2021-01-01
dc.identifier.citation	Palliative medicine, 2021, 35, (1), pp. 188-199
dc.identifier.issn	0269-2163
dc.identifier.issn	1477-030X
dc.identifier.uri	http://hdl.handle.net/10453/150594
dc.description.abstract	Background: Family meetings facilitate the exploration of issues and goals of care however, there has been minimal research to determine the benefits and cost implications. Aims: To determine: (1) if family caregivers of hospitalised patients referred to palliative care who receive a structured family meeting report lower psychological distress (primary outcome), fewer unmet needs, improved quality of life; feel more prepared for the caregiving role; and receive better quality of end-of-life care; (2) if outcomes vary dependant upon site of care and; (3) the cost-benefit of implementing meetings into routine practice. Design: Pragmatic cluster randomised trial involving palliative care patients and their primary family caregivers at three Australian hospitals. Participants completed measures upon admission (Time 1); 10 days later (Time 2) and two months after the patient died (Time 3). Regression analyses, health utilisation and process evaluation were conducted. Results: 297 dyads recruited; control (n = 153) and intervention (n = 144). The intervention group demonstrated significantly lower psychological distress (Diff: –1.68, p < 0.01) and higher preparedness (Diff: 3.48, p = 0.001) at Time 2. No differences were identified based on quality of end of life care or health utilisation measures. Conclusions: Family meetings may be helpful in reducing family caregiver distress and enhancing their preparedness for the caregiving role and it appears they may be conducted without increased hospital health utilisation impacts; although opportunity costs need to be considered in order to routinely offer these as a standardised intervention. Additional health economic examination is also advocated to comprehensively understand the cost-benefit implications.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	SAGE PUBLICATIONS LTD
dc.relation.ispartof	Palliative medicine
dc.relation.isbasedon	10.1177/0269216320967282
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject	1117 Public Health and Health Services, 1199 Other Medical and Health Sciences
dc.subject.classification	Gerontology
dc.subject.mesh	Humans
dc.subject.mesh	Palliative Care
dc.subject.mesh	Quality of Life
dc.subject.mesh	Caregivers
dc.subject.mesh	Cost-Benefit Analysis
dc.subject.mesh	Health Care Costs
dc.subject.mesh	Australia
dc.subject.mesh	New Zealand
dc.subject.mesh	Australia
dc.subject.mesh	Caregivers
dc.subject.mesh	Cost-Benefit Analysis
dc.subject.mesh	Health Care Costs
dc.subject.mesh	Humans
dc.subject.mesh	New Zealand
dc.subject.mesh	Palliative Care
dc.subject.mesh	Quality of Life
dc.title	Do family meetings for hospitalised palliative care patients improve outcomes and reduce health care costs? A cluster randomised trial.
dc.type	Journal Article
utslib.citation.volume	35
utslib.location.activity	England
utslib.for	1117 Public Health and Health Services
utslib.for	1199 Other Medical and Health Sciences
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Strength - CHT - Health Technologies
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/IMPACCT
pubs.organisational-group	/University of Technology Sydney/Centre for Health Technologies (CHT)
utslib.copyright.status	closed_access	*
pubs.consider-herdc	false
dc.date.updated	2021-09-16T05:32:18Z
pubs.issue	1
pubs.publication-status	Published
pubs.volume	35
utslib.citation.issue	1

Abstract:

Background: Family meetings facilitate the exploration of issues and goals of care however, there has been minimal research to determine the benefits and cost implications. Aims: To determine: (1) if family caregivers of hospitalised patients referred to palliative care who receive a structured family meeting report lower psychological distress (primary outcome), fewer unmet needs, improved quality of life; feel more prepared for the caregiving role; and receive better quality of end-of-life care; (2) if outcomes vary dependant upon site of care and; (3) the cost-benefit of implementing meetings into routine practice. Design: Pragmatic cluster randomised trial involving palliative care patients and their primary family caregivers at three Australian hospitals. Participants completed measures upon admission (Time 1); 10 days later (Time 2) and two months after the patient died (Time 3). Regression analyses, health utilisation and process evaluation were conducted. Results: 297 dyads recruited; control (n = 153) and intervention (n = 144). The intervention group demonstrated significantly lower psychological distress (Diff: –1.68, p < 0.01) and higher preparedness (Diff: 3.48, p = 0.001) at Time 2. No differences were identified based on quality of end of life care or health utilisation measures. Conclusions: Family meetings may be helpful in reducing family caregiver distress and enhancing their preparedness for the caregiving role and it appears they may be conducted without increased hospital health utilisation impacts; although opportunity costs need to be considered in order to routinely offer these as a standardised intervention. Additional health economic examination is also advocated to comprehensively understand the cost-benefit implications.

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http://hdl.handle.net/10453/150594