Geriatric palliative care: Meeting the needs of a growing population.
Rebecca M Saracino, Mei Bai, Leslie Blatt and 2 others
PMID 29042070WHAT IT FOUND
Pain was the main symptom addressed in palliative care consultations for older inpatients (73%), and goals-of-care discussions were linked to fewer readmissions.
Nurses can assess pain and consider early referral.
Key findings
01Pain management was the primary symptom addressed in 73% of consultations.
02Overall, 9.6% of patients were readmitted, and goals-of-care discussions during the initial consult were associated with lower odds of readmission (OR = 0.41).
03Goals-of-care discussions accounted for 34.2% of referrals, and end-of-life care planning accounted for 9.7%.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a retrospective record review, so it cannot show that palliative care consultation, goals-of-care discussions, or discharge location caused the observed differences in readmission. Only patients who had already been referred to palliative care were included, and there was no comparison group of older patients who were not referred. The goals-of-care definition was narrow, limited to discussions about transitioning to comfort care and implementing DNI or DNR orders. Important patient and social information, such as race, ethnicity, and socio-economic status, was not recorded. The data were collected from 2007 to 2012 at one hospital, so current practice elsewhere may differ.
The easy way to misread this
Do not conclude that goals-of-care discussions caused fewer readmissions. This was a retrospective analysis of patients already referred to palliative care, with no comparison group of patients who were not referred.