Outpatient palliative care (PC) benefits patients with Parkinson’s disease and related disorders (PDRD) more than standard care alone, according to the findings of a study published in JAMA Neurology.
In this randomized clinical trial, researchers enrolled 210 patients (64.3% men, mean age, 70) from three academic tertiary care centers between November 2015 and September 2017 and followed them for up to one year. The population of interest were required to have PDRD and moderate to high PC needs. The participants were assigned to receive either standard care plus integrated PC or only standard care. Outpatient integrated PC was provided by a neurologist, social worker, chaplain, and nurse using PC checklists, while standard care was administered by a neurologist and primary care physician.
The study’s primary endpoints were defined as the differences in patient quality of life (QoL) and caregiver burden between the two groups at six months. QoL was measured using the Quality of Life in Alzheimer Disease scale, and caregiver burden was assessed with the Zarit Burden Interview. The researchers analyzed data between November 2018 and December 9, 2019.
Palliative Care Improves Quality of Life
According to the results of the study, compared to standard care alone at six months, PDRD patients receiving the PC intervention showed better QoL (mean [SD], 0.66 [5.5] improvement vs 0.84 [4.2] worsening; treatment effect estimate=1.87; 95% CI, 0.47 to 3.27; P=.009). The researchers observed that there was no significant difference in caregiver burden (mean [SD], 2.3 [5.0] improvement vs 1.2 [5.6] improvement in the standard care group; treatment effect estimate, −1.62; 95% CI, −3.32 to 0.09; P = .06). They noted that other significant differences favoring the PC intervention over standard care alone for PDRD patients included nonmotor symptom burden, motor symptom severity, completion of advance directives, caregiver anxiety, and caregiver burden at 12 months. The results showed that no outcomes favored standard care alone.
Comparison of Palliative With Standard Care in Patients with Parkinson Disease and Related Disorders https://t.co/YPtf0z5K3P
— René Robles Cedeño (@reneroblesce) February 10, 2020
“This study supports efforts to integrate PC into PDRD care,” the research authors concluded. “The lack of diversity and implementation of PC at experienced centers suggests a need for implementation research in other populations and care settings.”
Interdisciplinary palliative care team (w/ selected use PC physician) improves quality of life, symptom burden, and advance directive completion in patients with Parkinson Disease: RCT from @uchealth in @JAMANeuro https://t.co/oruUXaQp8q @kutnerj #hpm #hapc #Parkinsons
— Arif Kamal MD, MBA, MHS, FAAHPM, FASCO (@arifkamalmd) February 11, 2020
— ResolutionCare (@MichaelDFratkin) February 11, 2020