Palliative care improves hospital care for seriously ill patients

Posted on: 04 May 2018

Palliative care provided by specialist medical and nursing teams to patients with complex health needs significantly improves their experience of care, new research from Trinity College Dublin shows.

Palliative care teams provide expert pain and symptom management guidance to patients in the treatment of serious illness.  They also provide care options before and after discharge and help patients and their families make the best decisions in relation to their needs.

The study that has just been published in JAMA Internal Medicine, estimated the effect of palliative care on 133,188 adults admitted to hospital in the United States. It was conducted in collaboration with the National Palliative Care Research Center at Mount Sinai Medical School in New York, and the Palliative Care Economics (PaCE) research group at Trinity’s Centre for Health Policy and Management.

The researchers found that not only is palliative care associated with a shorter hospital stay and lower costs, but that this effect is greatest for those with the most complex health needs often for whom the highest costs are associated with their care. This is the first study to show this association.   It follows multiple similar studies that found high-cost, poor value treatment patterns to be unavoidable among the sickest patients.

“People with serious and complex medical illness are a priority worldwide, due to the challenges in providing them with the best care, but also as they account heavily for health care spending yet experience poor outcomes,” says the study’s lead author Dr Peter May, Research Fellow in Health Economics at  Trinity College Dublin.

“The news that palliative care can significantly improve patient experience by reducing unnecessary procedures and expediting discharge is highly encouraging. It suggests that, through improved decision-making and communication, we can improve outcomes and curb costs even for those with advanced illness.”

Eighty per cent of deaths in Ireland occur with serious chronic disease, and Ireland has the fastest growing palliative care needs in Europe due to increasing numbers of death from cancer and neurodegenerative conditions including dementia.  International evidence suggests that people with serious chronic illness account for 50% of health care spending while constituting only 15% of the population, but that this expenditure yields poor value with patients and their families experiencing unmet symptom burden, high stress and poor quality of life, as well as lost earnings and severe financial pressures.

Senior author Professor Charles Normand said, “Although this study was conducted in the United States, its results should be of significant interest in Ireland and elsewhere in Europe.

“While some factors such as access and incentives may be context-specific, other challenges such as appropriate decision-making for people with complex illness in acute settings are universal.  Our results point to possible mechanisms to improving this decision-making.”