title: A shared care model pilot for palliative home care in a rural area: impact on symptoms, distress, and place of death.
abstract: BACKGROUND
  Shared care models integrating family physician services with interdisciplinary palliative care specialist teams are critical to improve access to quality palliative home care and address multiple domains of end-of-life issues and needs.
  
  
  OBJECTIVE
  To examine the impact of a shared care pilot program on the primary outcomes of symptom severity and emotional distress (patient and family separately) over time and, secondarily, the concordance between patient preferences and place of death.
  
  
  METHODS
  An inception cohort of patients (n = 95) with advanced, progressive disease, expected to die within six months, were recruited from three rural family physician group practices (21 physicians) and followed prospectively until death or pilot end. Serial measurement of symptoms, emotional distress (patient and family), and preferences for place of death was performed, with analysis of changes in distress outcomes assessed using t-tests and general linear models.
  
  
  RESULTS
  Symptoms trended toward improvement, with a significant reduction in anxiety from baseline to 14 days noted. Symptom and emotional distress were maintained below high severity (7-10), and a high rate of home death compared with population norms was observed.
  
  
  CONCLUSIONS
  Future controlled studies are needed to examine outcomes for shared care models with comparison groups. Shared care models build on family physician capacity and as such are promising in the development of palliative home care programs to improve access to quality palliative home care and foster health system integration.
authors.affiliation: Princess Margaret Hospital, University of Toronto, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada. doris.howell@uhn.on.ca
authors.forename: Doris
authors.initials: D
authors.lastname: Howell
authors.forename: Denise
authors.initials: D
authors.lastname: Marshall
authors.forename: Kevin
authors.initials: K
authors.lastname: Brazil
authors.forename: Alan
authors.initials: A
authors.lastname: Taniguchi
authors.forename: Michelle
authors.initials: M
authors.lastname: Howard
authors.forename: Gary
authors.initials: G
authors.lastname: Foster
authors.forename: Lehana
authors.initials: L
authors.lastname: Thabane
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000523:psychology*; D005260:Female; D006699:Home Care Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000523:psychology*; D010348:Patient Care Team; D011446:Prospective Studies; D013315:Stress, Psychological / Q000523:psychology*