• David Casarett, Amy Pickard, F Amos Bailey, Christine Ritchie, Christian Furman, Ken Rosenfeld, Scott Shreve, Zhen Chen, and Judy A Shea.
• Center for Health Equity Research and Promotion, Department of Veterans Affairs, Philadelphia, Pennsylvania, USA. Casarett@mail.med.upenn.edu
• J Am Geriatr Soc. 2008 Apr 1;56(4):593-9.

ObjectivesTo determine whether inpatient palliative consultation services improve outcomes of care.DesignRetrospective telephone surveys conducted with family members of veterans who received inpatient or outpatient care from a Department of Veterans Affairs (VA) medical facility in the last month of life.SettingFive VA Medical Centers or their affiliated nursing homes and outpatient clinics.ParticipantsVeterans had received inpatient or outpatient care from a participating VA in the last month of life. One family member completed each survey.MeasurementsThe telephone survey assessed nine aspects of the care the patient received in his or her last month of life: the patient's well-being and dignity (4 items), adequacy of communication (5 items), respect for treatment preferences (2 items), emotional and spiritual support (3 items), management of symptoms (4 items), access to the inpatient facility of choice (1 item), care around the time of death (6 items), access to home care services (4 items), and access to benefits and services after the patient's death (3 items).ResultsInterviews were completed with 524 respondents. In a multivariable linear regression model, after adjusting for the likelihood of receiving a palliative consultation (propensity score), palliative care patients had higher overall scores: 65 (95% confidence interval (CI)=62-66) versus 54 (95% CI=51-56; P<.001) and higher scores for almost all domains. Earlier consultations were independently associated with better overall scores (beta=0.003; P=.006), a difference that was attributable primarily to improvements in communication and emotional support.ConclusionPalliative consultations improve outcomes of care, and earlier consultations may confer additional benefit.

21 keywords...

hide…