Added Value of Early Consultation of an Inpatient Palliative Care Team in Hospitalized Older Patients With High Symptom Burden: A Prospective Comparative Study.
Myrthe W Naaktgeboren, Fabienne J H Magdelijns, Daisy J A Janssen and 1 others
PMID 33380163WHAT IT FOUND
Older inpatients with high symptom burden had improved symptom scores in both periods, and palliative care consultation did not increase the proportion who improved.
When the periods were analysed together, consultation was linked to more improvement, but the main period comparison was null.
Key findings
01The proportion of patients who improved on symptom distress did not differ between periods (45.8% in period 1 vs 56.7% in period 2).
02Symptom distress scores decreased from baseline to follow-up in both periods (period 1 50.5 to 42.8 points; period 2 35.1 to 24.0 points).
03In the total study population, patients with high symptom scores who received proactive consultation had 5 times higher chance of significant improvement than those who did not (adjusted odds ratio 4.895).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was not randomised, and the two periods differed at baseline, including symptom burden and length of stay. The main period comparison was null, so the positive combined analysis is an association rather than proof that consultation works. The study did not reach the number needed for the planned power calculation. It was done in one tertiary hospital, so it may not apply to other settings. Palliative care advice was written in the record but not discussed orally with attending physicians, and much of it was not followed, so the effect of the advice cannot be separated from usual hospital care. The surprise question and the symptom diary cut-off values are imperfect for identifying patients who need palliative care.
The easy way to misread this
Do not conclude that proactive palliative care consultation reliably improves symptoms. The main period comparison was null, and the positive 5 times finding came from a combined analysis after baseline differences between periods.