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. 2024 Jan 2;14(1):e058448.
doi: 10.1136/bmjopen-2021-058448.

Longitudinal symptom profile of palliative care patients receiving a nurse-led end-of-life (PEACH) programme to support preference to die at home

Meera Agar  1 , Wei Xuan  2 , Jessica Lee  3 , Gregory Barclay  4 , Alan Oloffs  5 , Kim Jobburn  1 , Janeane Harlum  1 , Nutan Maurya  1 , Josephine Sau Fan Chow  6
Affiliations

Longitudinal symptom profile of palliative care patients receiving a nurse-led end-of-life (PEACH) programme to support preference to die at home

Meera Agar et al. BMJ Open. .

Abstract

Objectives: Tailored models of home-based palliative care aimed to support death at home, should also ensure optimal symptom control. This study aimed to explore symptom occurrence and distress over time in Palliative Extended And Care at Home (PEACH) model of care recipients.

Design: This was a prospective cohort study.

Setting and participants: Participants were consecutive recipients of the PEACH rapid response nurse-led model of care in metropolitan Sydney (December 2013-January 2017) who were in the last weeks of life with a terminal or deteriorating phase of illness and had a preference to be cared or die at home.

Outcome measures: Deidentified data including sociodemographic and clinical characteristics, and symptom distress scores (Symptom Assessment Score) were collected at each clinical visit. Descriptive statistics and forward selection logistic regression analysis were used to explore influence of symptom distress levels on mode of separation ((1) died at home while still receiving a PEACH package, (2) admitted to a hospital or an inpatient palliative care unit or (3) discharged from the package (alive and no longer requiring PEACH)) across four symptom distress level categories.

Results: 1754 consecutive clients received a PEACH package (mean age 70 years, 55% male). 75.7% (n=1327) had a home death, 13.5% (n=237) were admitted and 10.8% (n=190) were still alive and residing at home when the package ceased. Mean symptom distress scores improved from baseline to final scores in the three groups (p<0.0001). The frequency of no symptom distress score (0) category was higher in the home death group. Higher scores for nausea, fatigue, insomnia and bowel problems were independent predictors of who was admitted.

Conclusion: Tailored home-based palliative care models to meet preference to die at home, achieve this while maintaining symptom control. A focus on particular symptoms may further optimise these models of care.

Keywords: Adult palliative care; GENERAL MEDICINE (see Internal Medicine); PALLIATIVE CARE.

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Conflict of interest statement

Competing interests: None declared.

References

    1. Baillie J, Anagnostou D, Sivell S, et al. Symptom management, nutrition and hydration at end-of-life: a qualitative exploration of patients’, carers’ and health professionals’ experiences and further research questions. BMC Palliat Care 2018;17:60. 10.1186/s12904-018-0314-4 - DOI - PMC - PubMed
    1. Singer AE, Meeker D, Teno JM, et al. Symptom trends in the last year of life from 1998 to 2010: a cohort study. Ann Intern Med 2015;162:175–83. 10.7326/M13-1609 - DOI - PMC - PubMed
    1. Kehl KA, Kowalkowski JA. A systematic review of the prevalence of signs of impending death and symptoms in the last 2 weeks of life. Am J Hosp Palliat Care 2013;30:601–16. 10.1177/1049909112468222 - DOI - PubMed
    1. Hoare S, Morris ZS, Kelly MP, et al. Do patients want to die at home? A systematic review of the UK literature, focused on missing preferences for place of death. PLoS One 2015;10:e0142723. 10.1371/journal.pone.0142723 - DOI - PMC - PubMed
    1. Nysæter TM, Olsson C, Sandsdalen T, et al. Preferences for home care to enable home death among adult patients with cancer in late palliative phase – a grounded theory study. BMC Palliat Care 2022;21:49. 10.1186/s12904-022-00939-y - DOI - PMC - PubMed