The Impact of Integrated Palliative Care on Survival in Idiopathic Pulmonary Fibrosis: A Retrospective Multicenter Comparison.
Jenny Lu-Song, Jeffrey A Bakal, Sarah Younus and 7 others
PMID 37553275WHAT IT FOUND
Palliative care was not linked to better survival before adjustment.
After adjusting for disease severity and treatments, patients receiving palliative care had lower risk of death, but this was not proven by a controlled trial.
Key findings
01Palliative care intervention did not show survival benefit in the unadjusted analysis, but the adjusted model 2 analysis reported aHR .28 (.12-.65).
02When the analysis was restricted to patients started on palliative care at the first visit, the survival signal was not statistically significant [aHR .55 (.17-1.72)].
03Edmonton and Bristol used primary palliative care models, while Kingston used specialist palliative care referral.
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 retrospective, so data were not collected to answer this question and patients were not randomized. The palliative care intervention was not uniform across sites, and the sites had different care teams, screening tools, and referral practices. Palliative care did not show survival benefit in the unadjusted analysis, and the adjusted benefit could be influenced by confounding from disease severity and treatments. The sensitivity analysis restricted to patients started on palliative care at the first visit was not statistically significant. The Kingston cohort had more patients in lower GAP stage, which may limit comparison with the Edmonton and Bristol cohorts. Patients who moved away or had missing data were censored, so follow-up was incomplete for some patients.
Declared interests
The authors declared no potential conflicts of interest. Funding was from the Alberta Respiratory Center, grant number [SC ZJ169], and Women and Children’s Health Research Institute at the University of Alberta.
The easy way to misread this
Do not read the adjusted survival benefit as proof that palliative care prolongs life. The unadjusted analysis did not show benefit, the sensitivity analysis was not significant, and the study could not rule out confounding by disease severity and treatments.