A Shared Care Model Pilot for Palliative Home Care in A Rural Area: Impact on Symptoms, Distress, and Place of Death

Abstract Context Shared care models integrating family physician services with interdisciplinary palliative care specialist teams are critical to improve access to quality palliative home care and address multiple domains of end-of-life issues and needs. Objectives To examine the impact of a shared...

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Bibliographic Details
Published in:Journal of pain and symptom management 2011-07, Vol.42 (1), p.60-75
Main Authors: Howell, Doris, RN, PhD, Marshall, Denise, BSc, MD, CCFP, FCFP, Brazil, Kevin, PhD, Taniguchi, Alan, MD, CCFP, Howard, Michelle, PhD, Foster, Gary, PhD, Thabane, Lehana, PhD
Format: Article
Language:English
Subjects:
Adult
Adult and adolescent clinical studies
Aged
Aged, 80 and over
Anesthesia & Perioperative Care
Anxiety - psychology
Biological and medical sciences
Doctors
Emotional distress
family physicians
Female
Home care
Home Care Services
Humans
interdisciplinary team
longitudinal
Male
Medical sciences
Middle Aged
Miscellaneous
outcome evaluation
outcomes research
Pain Medicine
Palliative care
Palliative Care - psychology
palliative home care
Patient Care Team
Pharmacology. Drug treatments
Prospective Studies
Psychology. Psychoanalysis. Psychiatry
Psychopathology. Psychiatry
Shared care
Stress, Psychological - psychology
Symptoms
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Summary:Abstract Context Shared care models integrating family physician services with interdisciplinary palliative care specialist teams are critical to improve access to quality palliative home care and address multiple domains of end-of-life issues and needs. Objectives To examine the impact of a shared care pilot program on the primary outcomes of symptom severity and emotional distress (patient and family separately) over time and, secondarily, the concordance between patient preferences and place of death. Methods An inception cohort of patients ( n = 95) with advanced, progressive disease, expected to die within six months, were recruited from three rural family physician group practices (21 physicians) and followed prospectively until death or pilot end. Serial measurement of symptoms, emotional distress (patient and family), and preferences for place of death was performed, with analysis of changes in distress outcomes assessed using t -tests and general linear models. Results Symptoms trended toward improvement, with a significant reduction in anxiety from baseline to 14 days noted. Symptom and emotional distress were maintained below high severity (7–10), and a high rate of home death compared with population norms was observed. Conclusion Future controlled studies are needed to examine outcomes for shared care models with comparison groups. Shared care models build on family physician capacity and as such are promising in the development of palliative home care programs to improve access to quality palliative home care and foster health system integration.
ISSN:0885-3924
1873-6513
DOI:10.1016/j.jpainsymman.2010.09.022