The imPaCT study: a randomised controlled trial to evaluate a hospital palliative care team

Abstract

A randomised controlled trial was undertaken to assess the effectiveness of a hospital Palliative Care Team (PCT) on physical symptoms and health-related quality of life (HRQoL); patient, family carer and primary care professional reported satisfaction with care; and health service resource use. The full package of advice and support provided by a multidisciplinary specialist PCT ('full-PCT') was compared with limited telephone advice ('telephone-PCT', the control group) in the setting of a teaching hospital trust in the SW of England. The trial recruited 261 out of 684 new inpatient referrals; 175 were allocated to 'full-PCT', 86 to 'telephone-PCT' (2 : 1 randomisation); with 191 (73%) being assessed at 1 week. There were highly significant improvements in symptoms, HRQoL, mood and 'emotional bother' in 'full-PCT' at 1 week, maintained over the 4-week follow-up. A smaller effect was seen in 'telephone-PCT'; there were no significant differences between the groups. Satisfaction with care in both groups was high and there was no significant difference between them. These data reflect a high standard of care of patients dying of cancer and other chronic diseases in an acute hospital environment, but do not demonstrate a difference between the two models of service delivery of specialist palliative care.

Strategies used in improving and assessing the level of reporting of implementation fidelity in randomised controlled trials of palliative care complex interventions: A systematic review

“…[28][29][30][31][54][55][56][57][58][59][60][61][62][63][64][65] All were carried out in developed countries with the majority being in the United States (nine of them) [20][21][22]28,30,31,33,[39][40][41][42][43][44][45][54][55][56][57][60][61][62][63][64][65] and in the United Kingdom (five). [23][24][25][26][27]29,37,38,58,59 As the focus of this review was to extract implementation fidelity strategies rather than to evaluate the effectiveness of the interventions used, only brief not...…”

“…In total, 10 trials were conducted exclusively with cancer patients, [20][21][22]27,[32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51] one exclusively on multiple sclerosis, [23][24][25][26] one exclusively on chronic heart failure, 52,53 whereas the remaining eight trials were not confined to a single diagnostic group. [28][29][30][31][54][55][56][57][58][59][60][61][62][63][64][65] All were carried out in developed countries with the majority being in the United States (nine of them) [20][21][22]…”

The need for new perspectives on evaluation of palliative care

“…Where such trials are reported, they often provide inconclusive evidence due to challenges associated with conducting trials in palliative care. 2 At worst, adopting a research design that cannot be successfully implemented may appear to undermine palliative care by failing to show any significant benefits of such care; at best it represents a considerable use of time and resources in return for limited results.…”

Maintenance of continuity of care in a rotating-physician model in an outpatient palliative care clinic

“…Several studies have documented the benefits of a palliative care service for inpatients in acute care settings [13,14] and outpatients in both clinic and hospice settings [4,15,16]. However, the role of continuity of physician care in these settings requires further exploration.…”