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Clinical Trial
. 2020 Aug 3;3(8):e2015061.
doi: 10.1001/jamanetworkopen.2020.15061.

Effect of Short-term Integrated Palliative Care on Patient-Reported Outcomes Among Patients Severely Affected With Long-term Neurological Conditions: A Randomized Clinical Trial

Wei Gao  1 , Rebecca Wilson  1 , Nilay Hepgul  1 , Deokhee Yi  1 , Catherine Evans  1   2 , Sabrina Bajwah  1 , Vincent Crosby  3 , Andrew Wilcock  4 , Fiona Lindsay  5 , Anthony Byrne  6 , Carolyn Young  7 , Karen Groves  8 , Clare Smith  9 , Rachel Burman  10 , K Ray Chaudhuri  11 , Eli Silber  12 , Irene J Higginson  1 ; OPTCARE Neuro Trial Investigators
Affiliations
Clinical Trial

Effect of Short-term Integrated Palliative Care on Patient-Reported Outcomes Among Patients Severely Affected With Long-term Neurological Conditions: A Randomized Clinical Trial

Wei Gao et al. JAMA Netw Open. .

Abstract

Importance: Palliative care has shown benefits in reducing symptom intensity and quality of life in patients with advanced cancer. However, high-quality evidence to support palliative care policy and service developments for patients with long-term neurological conditions (LTNCs) is lacking.

Objective: To determine the effectiveness of a short-term integrated palliative care (SIPC) intervention for people with LTNCs.

Design, setting, and participants: Multicenter, phase 3, randomized clinical trial conducted from April 1, 2015, to November 30, 2017, with a last follow-up date of May 31, 2018, in 7 UK hospitals with both neurology and palliative care services. A total of 535 patients with LTNC were assessed for eligibility and 350 were randomized. Inclusion criteria were patients 18 years or older with any advanced stage of multiple sclerosis, motor neuron disease, idiopathic Parkinson disease multiple system atrophy, or progressive supranuclear palsy. Data were analyzed from November 2018 to March 2019.

Interventions: Patients were randomized 1:1 using minimization method to receive SIPC (intervention, n = 176) or standard care (control, n = 174).

Main outcomes and measures: Primary outcome was change in 8 key palliative care symptoms from baseline to 12-weeks, measured by the Integrated Palliative care Outcome Scale for neurological conditions. Secondary outcomes included change in the burden of other symptoms, health-related quality of life, caregiver burden, and costs. Data were collected and analyzed blindly by intention to treat.

Results: A total of 350 patients (mean [SD] age 67 [12] years; years since diagnosis, 12 [range, 0-56]; 51% men; 49% requiring considerable assistance) with an advanced stage of LTNC were recruited, along with informal caregivers (n = 229). There were no between-group differences in primary outcome (effect size, -0.16; 95% CI, -0.37 to 0.05), any other patient-reported outcomes, adverse events, or survival. Although there was more symptom reduction in the SIPC group in relation to mean change in primary outcome, the difference between the groups was not statistically significant (-0.78; 95% CI, -1.29 to -0.26 vs -0.28; 95% CI, -0.82 to 0.26; P = .14). There was a decrease in mean health and social care costs from baseline to 12 weeks -$1367 (95% CI, -$2450 to -$282) in the SIPC group and -653 (95% CI, -$1839 to -$532) in the control group, but this difference was not statistically significant (P = .12). SIPC was perceived by patients and caregivers as building resilience, attending to function and deficits, and enabling caregivers.

Conclusions and relevance: In this study, SIPC was not statistically significantly different from standard care for the patient-reported outcomes. However, SIPC was associated with lower cost, and in qualitative analysis was well-received by patients and caregivers, and there were no safety concerns. Further research is warranted.

Trial registration: isrctn.org Identifier: ISRCTN18337380.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Gao reported receiving grants from the National Institute for Health Research (NIHR) during the conduct of the study. Dr Hepgul reported receiving grants from NIHR HS & DR during the conduct of the study. Dr Byrne reported receiving grants from Marie Curie during the conduct of the study; grants from Marie Curie and grants from the NIHR outside the submitted work. Dr Young reported receiving grants from the NIHR during the conduct of the study; grants from Motor Neuron Disease Association UK and grants from Multiple Sclerosis Society outside the submitted work. Dr Ray Chaudhuri reported receiving grants and other from EU, personal fees from Industry, and grants from WellcomeTrust outside the submitted work. Dr Higginson reported receiving grants from NIHR during the conduct of the study; and being NIHR Senior Investigator. No other disclosures were reported.

Figures

Figure.
Figure.. Consort Diagram Showing the Flow of Patients in OPTCARE Neuro Trial
See this image and copyright information in PMC

Comment in

References

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