Do Palliative Consultations Improve Patient Outcomes?
OBJECTIVES: To determine whether inpatient palliative consultation services improve outcomes of care. DESIGN: Retrospective telephone surveys conducted with family members of veterans who received inpatient or outpatient care from a Department of Veterans Affairs (VA) medical facility in the last mo...
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| Veröffentlicht in: | Journal of the American Geriatrics Society (JAGS) 2008-04, Vol.56 (4), p.593-599 |
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| container_title | Journal of the American Geriatrics Society (JAGS) |
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| creator | Casarett, David Pickard, Amy Bailey, F. Amos Ritchie, Christine Furman, Christian Rosenfeld, Ken Shreve, Scott Chen, Zhen Shea, Judy A. |
| description | OBJECTIVES: To determine whether inpatient palliative consultation services improve outcomes of care.
DESIGN: Retrospective telephone surveys conducted with family members of veterans who received inpatient or outpatient care from a Department of Veterans Affairs (VA) medical facility in the last month of life.
SETTING: Five VA Medical Centers or their affiliated nursing homes and outpatient clinics.
PARTICIPANTS: Veterans had received inpatient or outpatient care from a participating VA in the last month of life. One family member completed each survey.
MEASUREMENTS: The telephone survey assessed nine aspects of the care the patient received in his or her last month of life: the patient's well‐being and dignity (4 items), adequacy of communication (5 items), respect for treatment preferences (2 items), emotional and spiritual support (3 items), management of symptoms (4 items), access to the inpatient facility of choice (1 item), care around the time of death (6 items), access to home care services (4 items), and access to benefits and services after the patient's death (3 items).
RESULTS: Interviews were completed with 524 respondents. In a multivariable linear regression model, after adjusting for the likelihood of receiving a palliative consultation (propensity score), palliative care patients had higher overall scores: 65 (95% confidence interval (CI)=62–66) versus 54 (95% CI=51–56; P |
| doi_str_mv | 10.1111/j.1532-5415.2007.01610.x |
| format | Article |
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DESIGN: Retrospective telephone surveys conducted with family members of veterans who received inpatient or outpatient care from a Department of Veterans Affairs (VA) medical facility in the last month of life.
SETTING: Five VA Medical Centers or their affiliated nursing homes and outpatient clinics.
PARTICIPANTS: Veterans had received inpatient or outpatient care from a participating VA in the last month of life. One family member completed each survey.
MEASUREMENTS: The telephone survey assessed nine aspects of the care the patient received in his or her last month of life: the patient's well‐being and dignity (4 items), adequacy of communication (5 items), respect for treatment preferences (2 items), emotional and spiritual support (3 items), management of symptoms (4 items), access to the inpatient facility of choice (1 item), care around the time of death (6 items), access to home care services (4 items), and access to benefits and services after the patient's death (3 items).
RESULTS: Interviews were completed with 524 respondents. In a multivariable linear regression model, after adjusting for the likelihood of receiving a palliative consultation (propensity score), palliative care patients had higher overall scores: 65 (95% confidence interval (CI)=62–66) versus 54 (95% CI=51–56; P<.001) and higher scores for almost all domains. Earlier consultations were independently associated with better overall scores (β=0.003; P=.006), a difference that was attributable primarily to improvements in communication and emotional support.
CONCLUSION: Palliative consultations improve outcomes of care, and earlier consultations may confer additional benefit.</description><identifier>ISSN: 0002-8614</identifier><identifier>EISSN: 1532-5415</identifier><identifier>DOI: 10.1111/j.1532-5415.2007.01610.x</identifier><identifier>PMID: 18205757</identifier><identifier>CODEN: JAGSAF</identifier><language>eng</language><publisher>Malden, USA: Blackwell Publishing Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Biological and medical sciences ; end-of-life care ; Ethics ; Female ; General aspects ; Hospitals, Veterans ; Humans ; Inpatients ; Male ; measurement ; Medical sciences ; Middle Aged ; Outcome Assessment (Health Care) ; Outpatient Clinics, Hospital ; Outpatients ; Palliative care ; Palliative Care - methods ; Patient Satisfaction ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; quality improvement ; Quality of care ; Referral and Consultation - organization & administration ; Retrospective Studies ; Surveys and Questionnaires ; Teaching. Deontology. Ethics. Legislation ; United States ; Veterans</subject><ispartof>Journal of the American Geriatrics Society (JAGS), 2008-04, Vol.56 (4), p.593-599</ispartof><rights>2008, Copyright the Authors</rights><rights>2008 INIST-CNRS</rights><rights>Journal compilation © 2008, The American Geriatrics Society</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4620-46e8fadcb55ca3026ccc2620120e49aa05e48f080b30240465d2a4606011fc293</citedby><cites>FETCH-LOGICAL-c4620-46e8fadcb55ca3026ccc2620120e49aa05e48f080b30240465d2a4606011fc293</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1532-5415.2007.01610.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1532-5415.2007.01610.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=20567422$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18205757$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Casarett, David</creatorcontrib><creatorcontrib>Pickard, Amy</creatorcontrib><creatorcontrib>Bailey, F. Amos</creatorcontrib><creatorcontrib>Ritchie, Christine</creatorcontrib><creatorcontrib>Furman, Christian</creatorcontrib><creatorcontrib>Rosenfeld, Ken</creatorcontrib><creatorcontrib>Shreve, Scott</creatorcontrib><creatorcontrib>Chen, Zhen</creatorcontrib><creatorcontrib>Shea, Judy A.</creatorcontrib><title>Do Palliative Consultations Improve Patient Outcomes?</title><title>Journal of the American Geriatrics Society (JAGS)</title><addtitle>J Am Geriatr Soc</addtitle><description>OBJECTIVES: To determine whether inpatient palliative consultation services improve outcomes of care.
DESIGN: Retrospective telephone surveys conducted with family members of veterans who received inpatient or outpatient care from a Department of Veterans Affairs (VA) medical facility in the last month of life.
SETTING: Five VA Medical Centers or their affiliated nursing homes and outpatient clinics.
PARTICIPANTS: Veterans had received inpatient or outpatient care from a participating VA in the last month of life. One family member completed each survey.
MEASUREMENTS: The telephone survey assessed nine aspects of the care the patient received in his or her last month of life: the patient's well‐being and dignity (4 items), adequacy of communication (5 items), respect for treatment preferences (2 items), emotional and spiritual support (3 items), management of symptoms (4 items), access to the inpatient facility of choice (1 item), care around the time of death (6 items), access to home care services (4 items), and access to benefits and services after the patient's death (3 items).
RESULTS: Interviews were completed with 524 respondents. In a multivariable linear regression model, after adjusting for the likelihood of receiving a palliative consultation (propensity score), palliative care patients had higher overall scores: 65 (95% confidence interval (CI)=62–66) versus 54 (95% CI=51–56; P<.001) and higher scores for almost all domains. Earlier consultations were independently associated with better overall scores (β=0.003; P=.006), a difference that was attributable primarily to improvements in communication and emotional support.
CONCLUSION: Palliative consultations improve outcomes of care, and earlier consultations may confer additional benefit.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>end-of-life care</subject><subject>Ethics</subject><subject>Female</subject><subject>General aspects</subject><subject>Hospitals, Veterans</subject><subject>Humans</subject><subject>Inpatients</subject><subject>Male</subject><subject>measurement</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Outcome Assessment (Health Care)</subject><subject>Outpatient Clinics, Hospital</subject><subject>Outpatients</subject><subject>Palliative care</subject><subject>Palliative Care - methods</subject><subject>Patient Satisfaction</subject><subject>Public health. Hygiene</subject><subject>Public health. Hygiene-occupational medicine</subject><subject>quality improvement</subject><subject>Quality of care</subject><subject>Referral and Consultation - organization & administration</subject><subject>Retrospective Studies</subject><subject>Surveys and Questionnaires</subject><subject>Teaching. Deontology. Ethics. Legislation</subject><subject>United States</subject><subject>Veterans</subject><issn>0002-8614</issn><issn>1532-5415</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkN1r2zAUxcXoWLJ2_8Iwg_bN2ZWsrzyU0mZr2hKWQDcCexGKIoMzf6SWvaX__a5rk0Gfphfp6vzO5XAIiShMKJ7PuwkVCYsFp2LCANQEqETt8IaMj8IJGQMAi7WkfETeh7ADoAy0fkdGVDMQSqgxEV-qaGXzPLNN9ttHs6oMbd7ggI_ovtjXFf6ucPZlEy3bxlWFD1dn5G1q8-A_DPcp-XH79fvsLl4s5_ez60XsuGQQc-l1arduI4SzCTDpnGMoYAzPp9aC8FynoGGDIgcuxZZZLkECpalj0-SUXPR7McdT60Njiiw4n-e29FUbjAIuQGiK4KdX4K5q6xKzGUYhUYpNBUK6h1xdhVD71OzrrLD1s6Fgul7NznT1ma4-0_VqXno1B7R-HPa3m8Jv_xmHIhE4HwAbnM3T2pYuC0cOKak4Y8hd9tyfLPfP_x3APMwfuxf6496fhcYfjn5b_zJSJUqY9bc5puKwWN_-NDfJX8FRn1k</recordid><startdate>200804</startdate><enddate>200804</enddate><creator>Casarett, David</creator><creator>Pickard, Amy</creator><creator>Bailey, F. Amos</creator><creator>Ritchie, Christine</creator><creator>Furman, Christian</creator><creator>Rosenfeld, Ken</creator><creator>Shreve, Scott</creator><creator>Chen, Zhen</creator><creator>Shea, Judy A.</creator><general>Blackwell Publishing Inc</general><general>Blackwell</general><general>Wiley Subscription Services, Inc</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7TK</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>200804</creationdate><title>Do Palliative Consultations Improve Patient Outcomes?</title><author>Casarett, David ; Pickard, Amy ; Bailey, F. Amos ; Ritchie, Christine ; Furman, Christian ; Rosenfeld, Ken ; Shreve, Scott ; Chen, Zhen ; Shea, Judy A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4620-46e8fadcb55ca3026ccc2620120e49aa05e48f080b30240465d2a4606011fc293</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>end-of-life care</topic><topic>Ethics</topic><topic>Female</topic><topic>General aspects</topic><topic>Hospitals, Veterans</topic><topic>Humans</topic><topic>Inpatients</topic><topic>Male</topic><topic>measurement</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Outcome Assessment (Health Care)</topic><topic>Outpatient Clinics, Hospital</topic><topic>Outpatients</topic><topic>Palliative care</topic><topic>Palliative Care - methods</topic><topic>Patient Satisfaction</topic><topic>Public health. Hygiene</topic><topic>Public health. Hygiene-occupational medicine</topic><topic>quality improvement</topic><topic>Quality of care</topic><topic>Referral and Consultation - organization & administration</topic><topic>Retrospective Studies</topic><topic>Surveys and Questionnaires</topic><topic>Teaching. Deontology. Ethics. Legislation</topic><topic>United States</topic><topic>Veterans</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Casarett, David</creatorcontrib><creatorcontrib>Pickard, Amy</creatorcontrib><creatorcontrib>Bailey, F. Amos</creatorcontrib><creatorcontrib>Ritchie, Christine</creatorcontrib><creatorcontrib>Furman, Christian</creatorcontrib><creatorcontrib>Rosenfeld, Ken</creatorcontrib><creatorcontrib>Shreve, Scott</creatorcontrib><creatorcontrib>Chen, Zhen</creatorcontrib><creatorcontrib>Shea, Judy A.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American Geriatrics Society (JAGS)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Casarett, David</au><au>Pickard, Amy</au><au>Bailey, F. Amos</au><au>Ritchie, Christine</au><au>Furman, Christian</au><au>Rosenfeld, Ken</au><au>Shreve, Scott</au><au>Chen, Zhen</au><au>Shea, Judy A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Do Palliative Consultations Improve Patient Outcomes?</atitle><jtitle>Journal of the American Geriatrics Society (JAGS)</jtitle><addtitle>J Am Geriatr Soc</addtitle><date>2008-04</date><risdate>2008</risdate><volume>56</volume><issue>4</issue><spage>593</spage><epage>599</epage><pages>593-599</pages><issn>0002-8614</issn><eissn>1532-5415</eissn><coden>JAGSAF</coden><abstract>OBJECTIVES: To determine whether inpatient palliative consultation services improve outcomes of care.
DESIGN: Retrospective telephone surveys conducted with family members of veterans who received inpatient or outpatient care from a Department of Veterans Affairs (VA) medical facility in the last month of life.
SETTING: Five VA Medical Centers or their affiliated nursing homes and outpatient clinics.
PARTICIPANTS: Veterans had received inpatient or outpatient care from a participating VA in the last month of life. One family member completed each survey.
MEASUREMENTS: The telephone survey assessed nine aspects of the care the patient received in his or her last month of life: the patient's well‐being and dignity (4 items), adequacy of communication (5 items), respect for treatment preferences (2 items), emotional and spiritual support (3 items), management of symptoms (4 items), access to the inpatient facility of choice (1 item), care around the time of death (6 items), access to home care services (4 items), and access to benefits and services after the patient's death (3 items).
RESULTS: Interviews were completed with 524 respondents. In a multivariable linear regression model, after adjusting for the likelihood of receiving a palliative consultation (propensity score), palliative care patients had higher overall scores: 65 (95% confidence interval (CI)=62–66) versus 54 (95% CI=51–56; P<.001) and higher scores for almost all domains. Earlier consultations were independently associated with better overall scores (β=0.003; P=.006), a difference that was attributable primarily to improvements in communication and emotional support.
CONCLUSION: Palliative consultations improve outcomes of care, and earlier consultations may confer additional benefit.</abstract><cop>Malden, USA</cop><pub>Blackwell Publishing Inc</pub><pmid>18205757</pmid><doi>10.1111/j.1532-5415.2007.01610.x</doi><tpages>7</tpages></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Biological and medical sciences end-of-life care Ethics Female General aspects Hospitals, Veterans Humans Inpatients Male measurement Medical sciences Middle Aged Outcome Assessment (Health Care) Outpatient Clinics, Hospital Outpatients Palliative care Palliative Care - methods Patient Satisfaction Public health. Hygiene Public health. Hygiene-occupational medicine quality improvement Quality of care Referral and Consultation - organization & administration Retrospective Studies Surveys and Questionnaires Teaching. Deontology. Ethics. Legislation United States Veterans |
| title | Do Palliative Consultations Improve Patient Outcomes? |
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