Do palliative consultations improve patient outcomes?
OBJECTIVE
To determine whether inpatient palliative consultation services improve outcomes of care.


METHODS
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.


METHODS
Five VA Medical Centers or their affiliated nursing homes and outpatient clinics.


METHODS
Veterans had received inpatient or outpatient care from a participating VA in the last month of life. One family member completed each survey.


METHODS
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 (beta=0.003; P=.006), a difference that was attributable primarily to improvements in communication and emotional support.


CONCLUSIONS
Palliative consultations improve outcomes of care, and earlier consultations may confer additional benefit.
Casarett
David
D
Center for Health Equity Research and Promotion, Department of Veterans Affairs, Philadelphia, Pennsylvania, USA. Casarett@mail.med.upenn.edu
Pickard
Amy
A
Bailey
F Amos
FA
Ritchie
Christine
C
Furman
Christian
C
Rosenfeld
Ken
K
Shreve
Scott
S
Chen
Zhen
Z
Shea
Judy A
JA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010044:Outpatient Clinics, Hospital; D010045:Outpatients; D010166:Palliative Care / Q000379:methods*; D017060:Patient Satisfaction; D012017:Referral and Consultation / Q000458:organization & administration*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D014481:United States