title: The effect of palliative care on patient functioning.
abstract: BACKGROUND
  Palliative care is increasingly viewed as a care option that should not only be offered to patients very near the end of life. An important question is whether increased use of palliative care soon after a patient's referral will improve patient functioning, an aspect of quality of life.
  
  
  OBJECTIVE
  The aim of this study was to determine if increased use of palliative care is associated with increased patient functioning.
  
  
  METHODS
  The Carolinas Palliative Care Database Consortium collects palliative care encounter data from a variety of providers, settings, and patients, and it measures patient functioning, allowing us to test the hypothesis that increased use of palliative care early in a patient's palliative care experience will improve patient functioning.
  
  
  RESULTS
  After controlling for other factors that could explain patient functioning, we find that each additional palliative care visit during the first month of follow-up increases patient functioning measured using an area under the curve (AUC) approach (0.008 per visit, p=0.01). However, patient functioning as measured at the initial visit is a far stronger predictor of subsequent functioning (0.52, p<0.001) than are additional palliative care visits.
  
  
  CONCLUSIONS
  Increased use of palliative care was associated with improved patient functioning. This held true at very low as well as very high levels of initial functioning. The strongest predictor of subsequent patient functioning is their initial status. Accounting for patient-specific differences to precisely determine the impact of palliative care on patient functioning is difficult.
authors.affiliation: 1 Duke Sanford School of Public Policy, Duke University , Durham, North Carolina.
authors.forename: Donald H
authors.initials: DH
authors.lastname: Taylor
authors.forename: Janet
authors.initials: J
authors.lastname: Bull
authors.forename: Xiaoyin
authors.initials: X
authors.lastname: Zhong
authors.forename: Greg
authors.initials: G
authors.lastname: Samsa
authors.forename: Amy P
authors.initials: AP
authors.lastname: Abernethy
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D009657:North Carolina; D010166:Palliative Care; D011788:Quality of Life; D012017:Referral and Consultation; D013727:Terminal Care
references.citation: J Palliat Med. 2010 Aug;13(8):1013-20
references.pmid: 20649439
references.citation: MMWR Morb Mortal Wkly Rep. 2011 Mar 11;60(9):269-72
references.pmid: 21389929
references.citation: Res Nurs Health. 1994 Oct;17(5):371-9
references.pmid: 8090948
references.citation: Med Care. 2005 Oct;43(10):1054-7
references.pmid: 16166876
references.citation: PLoS One. 2010 Mar 09;5(3):e9584
references.pmid: 20231893
references.citation: J Clin Oncol. 2003 Apr 1;21(7):1412-5
references.pmid: 12663735
references.citation: Contemp Clin Trials. 2006 Feb;27(1):83-100
references.pmid: 16290094
references.citation: J Pain Symptom Manage. 1995 Aug;10(6):423-31
references.pmid: 7561224
references.citation: J Pain Symptom Manage. 2013 Mar;45(3):488-505
references.pmid: 23102711
references.citation: J Palliat Care. 1996 Spring;12(1):5-11
references.pmid: 8857241
references.citation: N Engl J Med. 2010 Aug 19;363(8):733-42
references.pmid: 20818875
references.citation: Cancer Nurs. 1978 Oct;1(5):373-8
references.pmid: 250445
references.citation: J Vasc Surg. 2005 Apr;41(4):625-30
references.pmid: 15874926
references.citation: Curr Oncol. 2007 Dec;14(6):234-7
references.pmid: 18080015