title: Palliative care for patients with advanced fibrotic lung disease: a randomised controlled phase II and feasibility trial of a community case conference intervention.
abstract: BACKGROUND
  Those affected by advanced fibrotic interstitial lung diseases (ILDs) have considerable unmet symptom and psychological needs. Case conferencing has been proposed to address these issues, but requires evaluation.
  
  
  OBJECTIVE
  To obtain preliminary information on the impact of a case conference intervention delivered in the home (Hospital2Home) on palliative care concerns of patients and their carers, and to evaluate feasibility and acceptability.
  
  
  METHODS
  Hospital2Home was trialled at a specialist centre using a Phase II fast-track randomised controlled trial with qualitative interviews. The primary outcome for effect was mean change from baseline of Palliative Care Outcome Scale (POS) (a measure of symptoms and concerns) at 4 weeks. Secondary outcomes included symptom control, quality of life, consent and recruitment rates and percentage of patients in the fast-track group receiving case conferences within 14 days.
  
  
  RESULTS
  53 patients were recruited (26 fast-track, 27 controls). Mean (SD) POS scores at 4 weeks were -5.7 (7.5) fast-track vs -0.4 (8.0) control, (mean change difference between the two arms was -5.3 (95% CI -9.8 to -0.7) independent t test p=0.02); effect size (95% CI) -0.7 (-1.2 to -0.1). The secondary outcomes of quality of life, anxiety and depression were superior in the fast-track arm, and none were worse. Qualitative findings corroborate these data. Recruitment was successful and 53/67 (79%) of eligible patients consented. 6/25 (24%) had case conferences within 14 days.
  
  
  CONCLUSIONS
  Community case conferences improve palliative symptoms and quality of life after 4 weeks. Hospital2Home for the most part is both feasible and acceptable. It now requires further testing in multicentre trials.
  
  
  BACKGROUND
  NCT01450644.
authors.affiliation: Department of Palliative Medicine, Royal Marsden and Royal Brompton NHS Foundation Trusts, London, UK Department of Palliative Care, King's College London, Cicely Saunders Institute, Policy & Rehabilitation, London, UK.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Bajwah
authors.affiliation: Department of Palliative Medicine, Royal Marsden and Royal Brompton NHS Foundation Trusts, London, UK National Heart and Lung Institute, Imperial College, London, UK.
authors.forename: Joy R
authors.initials: JR
authors.lastname: Ross
authors.affiliation: National Heart and Lung Institute, Imperial College, London, UK Department of Respiratory Medicine, Royal Brompton NHS Foundation Trust, London, UK.
authors.forename: Athol U
authors.initials: AU
authors.lastname: Wells
authors.affiliation: Department of Statistics, Royal Marsden NHS Foundation Trust, London, UK.
authors.forename: Kabir
authors.initials: K
authors.lastname: Mohammed
authors.affiliation: Department of Palliative Medicine, Royal Marsden and Royal Brompton NHS Foundation Trusts, London, UK.
authors.forename: Christina
authors.initials: C
authors.lastname: Oyebode
authors.affiliation: Division of Asthma, Allergy and Lung Biology, King's College London, London, UK.
authors.forename: Surinder S
authors.initials: SS
authors.lastname: Birring
authors.affiliation: Division of Asthma, Allergy and Lung Biology, King's College London, London, UK.
authors.forename: Amit S
authors.initials: AS
authors.lastname: Patel
authors.affiliation: Department of Palliative Care, King's College London, Cicely Saunders Institute, Policy & Rehabilitation, London, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Koffman
authors.affiliation: Department of Palliative Care, King's College London, Cicely Saunders Institute, Policy & Rehabilitation, London, UK.
authors.forename: Irene J
authors.initials: IJ
authors.lastname: Higginson
authors.affiliation: Department of Palliative Medicine, Royal Marsden and Royal Brompton NHS Foundation Trusts, London, UK National Heart and Lung Institute, Imperial College, London, UK.
authors.forename: Julia
authors.initials: J
authors.lastname: Riley
mesh_terms: D000328:Adult; D000368:Aged; D017028:Caregivers / Q000523:psychology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D011658:Pulmonary Fibrosis / Q000628:therapy*; D011788:Quality of Life / Q000523:psychology*
keywords: Idiopathic pulmonary fibrosis; Palliative Care