• Laura C Hanson, Christine E Kistler, Kyle Lavin, Stacey L Gabriel, Natalie C Ernecoff, Feng-Chang Lin, Greg A Sachs, and Susan L Mitchell.
• Division of Geriatric Medicine and Palliative Care Program, Cecil G. Sheps Center for Health Services Research, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA. Electronic address: lhanson@med.unc.edu.
• J Pain Symptom Manage. 2019 Jan 1; 57 (1): 10-19.

ContextPersons with late-stage dementia have limited access to palliative care.ObjectiveThe objective of this study was to test dementia-specific specialty palliative care triggered by hospitalization.MethodsThis 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.ResultsOf 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 days, P = 0.415). Intervention patients had more palliative care domains addressed and were more likely to receive hospice (25% vs. 3%, P < 0.019). Intervention families were more likely to discuss prognosis (90% vs. 3%, P < 0.001) and goals of care (90% vs. 25%, P < 0.001) and to have a MOST at 60-day follow-up (79% vs. 30%, P < 0.001). More intervention families made decisions to avoid rehospitalization (13% vs. 0%, P = 0.033).ConclusionSpecialty palliative care consultation for hospitalized patients with late-stage dementia is feasible and promising to improve decision-making and some treatment outcomes.Copyright © 2018 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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