University of Sussex
Browse
1-s2.0-S0020748921001231-main.pdf (1.14 MB)

Community-based short-term integrated palliative and supportive care reduces symptom distress for older people with noncancer conditions compared with usual care: a randomised controlled single-blind mixed method trial

Download (1.14 MB)
journal contribution
posted on 2023-06-09, 23:57 authored by Catherine J Evans, Anna E Bone, Deokhee Yi, Wei Gao, Myfanwy Morgan, Shamim Taherzadeh, Matthew Maddocks, Juliet Wright, Fiona Lindsay, Carla Bruni, Richard Harding, Katherine E Sleeman, Barbara Gomes, Irene J Higgingson
Background: Globally, a rising number of people live into advanced age and die with multimorbidity and frailty. Palliative care is advocated as a person-centred approach to reduce health-related suffering and promote quality of life. However, no evidence-based interventions exist to deliver community-based palliative care for this population. Aim: To evaluate the impact of the short-term integrated palliative and supportive care intervention for older people living with chronic noncancer conditions and frailty on clinical and economic outcomes and perceptions of care. Design: Single-blind trial with random block assignment to usual care or the intervention and usual care. The intervention comprised integrated person-centred palliative care delivered by multidisciplinary palliative care teams working with general practitioners and community nurses. Main outcome was change in five key palliative care symptoms from baseline to 12-weeks. Data analysis used intention to treat and complete cases to examine the mean difference in change scores and effect size between the trial arms. Economic evaluation used cost-effectiveness planes and qualitative interviews explored perceptions of the intervention. Setting/participants: Four National Health Service general practices in England with recruitment of patients aged >75 years, with moderate to severe frailty, chronic noncancer condition(s) and >2 symptoms or concerns, and family caregivers when available. Results: 50 patients were randomly assigned to receive usual care (n=26, mean age 86.0 years) or the intervention and usual care (n=24, mean age 85.3 years), and 26 caregivers (control n=16, mean age 77.0 years; intervention n=10, mean age 77.3 years). Participants lived at home (n=48) or care home (n=2). Complete case analysis (n=48) on the main outcome showed reduced symptom distress between the intervention compared with usual care (mean difference -1.20, 95% confidence interval -2.37 to -0.027) and medium effect size (omega squared=0.071). Symptom distress reduced with decreased costs from the intervention compared with usual care, demonstrating cost-effectiveness. Patient (n=19) and caregiver (n=9) interviews generated themes about the intervention of ‘Little things make a big difference’ with optimal management of symptoms and ‘Care beyond medicines’ of psychosocial support to accommodate decline and maintain independence. Conclusions: This palliative and supportive care intervention is an effective and cost-effective approach to reduce symptom distress for older people severely affected by chronic noncancer conditions. It is a clinically effective way to integrate specialist palliative care with primary and community care for older people with chronic conditions. Further research is indicated to examine its implementation more widely for people at home and in care homes. Trial registration: Controlled-Trials.com ISRCTN 45837097 Tweetable abstract: Specialist palliative care integrated with district nurses and GPs is cost-effective to reduce symptom distress for older people severely affected by chronic conditions.

History

Publication status

  • Published

File Version

  • Accepted version

Journal

International Journal of Nursing Studies

ISSN

0020-7489

Publisher

Elsevier

Volume

120

Page range

1-13

Article number

a103978

Department affiliated with

  • Clinical and Experimental Medicine Publications

Full text available

  • Yes

Peer reviewed?

  • Yes

Legacy Posted Date

2021-05-28

First Open Access (FOA) Date

2021-05-28

First Compliant Deposit (FCD) Date

2021-05-28

Usage metrics

    University of Sussex (Publications)

    Categories

    No categories selected

    Licence

    Exports

    RefWorks
    BibTeX
    Ref. manager
    Endnote
    DataCite
    NLM
    DC