TY - JOUR
T1 - Community-based short-term integrated palliative and supportive care reduces symptom distress for older people with chronic noncancer conditions compared with usual care: a randomised controlled single-blind mixed method trial
AU - Evans, Catherine
AU - Bone, Anna
AU - Yi, Deok Hee
AU - Gao, Wei
AU - Morgan, Myfanwy
AU - Taherzadeh, Shamin
AU - Maddocks, Matthew
AU - Wright, Juliet
AU - Lindsay, Fiona
AU - Bruni, Carla
AU - Harding, Richard
AU - Sleeman, Katherine
AU - Gomes, Barbara
AU - Higginson, Irene
N1 - Funding Information:
The study Optimising PalliaTive care for Older People (OPTCare Elderly) aimed to develop and evaluate a community-based short-term integrated palliative and supportive care model for older people with chronic noncancer conditions and frailty living at home or in a care home. OPTCare Elderly is a joint project between King's College London and Sussex Community NHS Foundation Trust. The following are members of the OPTCare Elderly Team: Principal Investigator: Catherine J. Evans; Co-Principal Investigator: Irene J Higginson; Co-applicants: Myfanwy Morgan, Paul McCrone, Wei Gao, Juliet Wright, Sue Hall, Barbara Gomes, Emma Gordon, Fiona Lindsay, Carla Bruni, Shamim Taherzadeh; Steering Group: Richard Harding, Katherine E. Sleeman, Matthew Maddocks, Helen Colvin, Anita Wright, Sue Guerrier; Independent Project Advisory Group: John Barry, Lesley Talmey, Colin Vincent, Mike Bojczuk, Jack Hazelgrove; Researchers: Anna E. Bone, Deokhee Yi, Rowena Vohora, Katie Stone, Mark Philips. Research nurses: Nina Walters, Kate Porter, Claire Cox. Thank you to Mendwas Dzingina for advice on the economic evaluation, Massimo Constantino for reviewing an earlier draft of the manuscript and India Tunnard for supporting manuscript preparation. The OPTCare Elderly Study is funded by the National Institute for Health Research (NIHR) Research for Patient Benefit Programme (Project PB-PG-1111?26071). CE is funded by a Health Education England/ NIHR Clinical Lectureship (CAT-CL-10-003) and Senior Clinical Lectureship (ICA-SCL-2015-01-001); MM by an NIHR Career Development Fellowship (CDF-2017e10-009); and KES by a NIHR Clinician Scientist Fellowship (CS-2015-15-005).WG, MM and IJH are supported by the NIHR Applied Research Collaboration South London (NIHR ARC South London) at King's College Hospital NHS Foundation Trust. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute of Health Research or the Department of Health and Social Care.
Funding Information:
The OPTCare Elderly Study is funded by the National Institute for Health Research (NIHR) Research for Patient Benefit Programme (Project PB-PG-1111–26071). CE is funded by a Health Education England/ NIHR Clinical Lectureship (CAT-CL-10-003) and Senior Clinical Lectureship (ICA-SCL-2015-01-001); MM by an NIHR Career Development Fellowship (CDF-2017e10-009); and KES by a NIHR Clinician Scientist Fellowship (CS-2015-15-005).WG, MM and IJH are supported by the NIHR Applied Research Collaboration South London (NIHR ARC South London) at King's College Hospital NHS Foundation Trust. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute of Health Research or the Department of Health and Social Care.
Publisher Copyright:
© 2021
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/8/1
Y1 - 2021/8/1
N2 - 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.
AB - 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.
KW - Aged
KW - palliative care
KW - community health nursing
KW - General Practice
KW - Randomized clinical trial
KW - Costs and Cost Analysis
KW - Qualitative interviews
UR - http://www.scopus.com/inward/record.url?scp=85108002884&partnerID=8YFLogxK
U2 - 10.1016/j.ijnurstu.2021.103978
DO - 10.1016/j.ijnurstu.2021.103978
M3 - Article
VL - 120
JO - International Journal of Nursing Studies
JF - International Journal of Nursing Studies
M1 - 103978
ER -