Assessing the effectiveness of a hospital palliative care team.
A prospective study was carried out of 125 hospital inpatients with malignant disease, referred to the King's College Hospital advisory palliative care team. A palliative care assessment (PACA) tool was developed in order to assess the outcome of interventions made within two weeks of referral with regard to: symptom control, change in the patients' and their relatives' insight regarding diagnosis and prognosis, and facilitation of patient placement. Reliability was assessed by cross-observer analysis, and validity by comparison with data obtained using the McCorckle symptom distress scale in a separate group of hospice inpatients. At initial assessment, the commonest symptom was pain, as reported by 74% of patients. One-third of the patients were unsure of their diagnosis and placement had not been decided in 61%. In total, the team undertook 245 pharmacological interventions for symptom control, 165 interventions regarding insight and 114 interventions concerning placement. Analysis of the data showed statistically significant improvements in pain (p < 0.001), nausea (p < 0.009), insomnia (p < 0.004), anorexia (p < 0.001) and constipation (p < 0.02). Discussion regarding diagnosis significantly changed the insight of patients (p < 0.001) and relatives (p < 0.02). Appropriate placement was assisted by interventions undertaken by the team. This study shows that a hospital palliative care team is effective at improving symptom control, facilitates understanding of the diagnosis and prognosis, and contributes to the appropriate placement of patients.
Ellershaw
J E
JE
Pain Relief Research Unit, King's College Hospital, London, UK.
Peat
S J
SJ
Boys
L C
LC
D002173:Cancer Care Facilities; D017051:Hospice Care; D006801:Humans; D009369:Neoplasms / Q000451:nursing*; D017063:Outcome Assessment, Health Care; D010166:Palliative Care; D010353:Patient Education as Topic; D011446:Prospective Studies; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires