Triggered Palliative Care for Late-Stage Dementia: A Pilot Randomized Trial.

Abstract

CONTEXT\nPersons with late-stage dementia have limited access to palliative care.\n\n\nOBJECTIVE\nThe objective of this study was to test dementia-specific specialty palliative care triggered by hospitalization.\n\n\nMETHODS\nThis pilot randomized controlled trial enrolled 62 dyads of persons with late-stage dementia and family decision-makers on admission to hospital. Intervention dyads received dementia-specific specialty palliative care consultation plus postacute transitional care. Control dyads received usual care and educational information. The primary outcome was 60-day hospital or emergency department visits. Secondary patient- and family-centered outcomes were patient comfort, family distress, palliative care domains addressed in the treatment plan, and access to hospice or community-based palliative care. Secondary decision-making outcomes were discussion of prognosis, goals of care, completion of Medical Orders for Scope of Treatment (MOST), and treatment decisions.\n\n\nRESULTS\nOf 137 eligible dyads, 62 (45%) were enrolled. The intervention proved feasible, with protocol completion ranging from 77% (family two-week call) to 93% (initial consultation). Hospital and emergency department visits did not differ (intervention vs. control, 0.68 vs. 0.53 transfers per 60\xa0days, P\xa0=\xa00.415). Intervention patients had more palliative care domains addressed and were more likely to receive hospice (25% vs. 3%, P\xa0<\xa00.019). Intervention families were more likely to discuss prognosis (90% vs. 3%, P\xa0<\xa00.001) and goals of care (90% vs. 25%, P\xa0<\xa00.001) and to have a MOST at 60-day follow-up (79% vs. 30%, P\xa0<\xa00.001). More intervention families made decisions to avoid rehospitalization (13% vs. 0%, P\xa0=\xa00.033).\n\n\nCONCLUSION\nSpecialty palliative care consultation for hospitalized patients with late-stage dementia is feasible and promising to improve decision-making and some treatment outcomes.