The comprehensive care team: a description of a controlled trial of care at the beginning of the end of life

Abstract

Objective: To describe the characteristics, acceptability, and basic efficacy of an outpatient palliative care consultation service for patients with serious illness continuing to receive treatment for their underlying disease.

Design: Structured interviews of intervention patients enrolled in a prospective, nonrandomized, controlled trial.

Setting: General medicine practice in an urban, academic medical center.

Patients: Ninety outpatients with cancer, advanced congestive heart failure, or advanced chronic obstructive pulmonary disease.

Interventions: Palliative care consultation to primary care physicians (PCPs); educational and supportive services to patients and their families.

Outcome measures: Physician referrals, program assessment by patients, observations of clinical consultation team members.

Results: A majority of PCPs (61%) referred patients to the project, which provided an extensive panel of services despite significant financial constraints. Patients reported improved satisfaction with their family (85.7%), PCP (80%), and the medical center at large (65.7%) as a result of these services. Patients found discussing advance care planning difficult (66%), but desired these conversations (66%). Team members observed significant palliative care needs among this population of outpatients, however, PCPs did not implement a significant number of the consultation team's recommendations.

Conclusions: Outpatient palliative care consultation and services for patients continuing to pursue treatment of their underlying disease are acceptable and helpful to patients. However, barriers to implementation of palliative care treatments in this population must be explored.