Do case conferences between general practitioners and specialist palliative care services improve quality of life? A randomised controlled trial (ISRCTN 52269003).
Australian palliative care is delivered by general practitioners (GPs) and specialist palliative care teams. Patient outcomes should improve if they work in formal partnership. We conducted a multi-centred randomised controlled trial of specialist- GP case conferences, with the GP participating by teleconference, or usual care and communication methods. Primary outcome measure was global Quality of Life (QoL) scores at 3 weeks from intervention. Secondary measures included subscale QoL scores and carer burden. Two a priori intention-to-treat analyses were conducted using recruitment, and time of death, as fixed time points. There was no difference between groups in the magnitude of change in global QoL measures from baseline to any time point up to 9 weeks post-case conference, or at any time before death. The case conference group showed better maintenance of some physical and mental health measures of QoL in the 35 days before death. Case conferences may improve clinical relationships and care plans at referral, which are not implemented until severe symptoms develop. Case conferences between GPs and specialist palliative care services may be warranted for palliative care patients.
Mitchell
G K
GK
Discipline of General Practice, University of Queensland, Medical School, Brisbane, Queensland, Australia. g.mitchell@uq.edu.au
Del Mar
C B
CB
O'Rourke
P K
PK
Clavarino
A M
AM
D001291:Attitude of Health Personnel; D001315:Australia; D017028:Caregivers; D003695:Delivery of Health Care / Q000458:organization & administration / Q000592:standards*; D005194:Family Practice / Q000458:organization & administration* / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D010166:Palliative Care / Q000458:organization & administration* / Q000592:standards; D010348:Patient Care Team / Q000458:organization & administration* / Q000592:standards; D011788:Quality of Life / Q000523:psychology; D013685:Telecommunications