Background and Significance
The effect palliative care has on patient outcomes and satisfaction has been investigated in populations with specific diagnoses and sites of care with favorable results. In patients with cancer, palliative care improved quality of life and mood in both rural and urban outpatient settings in randomized controlled trials.
Examples of studies specific to sites of care include palliative care provided in a clinic, long-term care, in the patient's home, or in case management models. Of these sites, studies of palliative care provided at home demonstrated the strongest evidence of benefit through a reduction in transitions to acute care, a reduction in pain, and enhanced patient satisfaction. Increased patient satisfaction related to fewer or smoother transitions between sites of care was a recurring theme in these studies.
Transitional care provides services for highly vulnerable, chronically ill individuals during transitions between sites of healthcare. Educating patients and families and assisting them in determining their own goals of care are believed to improve outcomes and prevent unnecessary rehospitalizations. Palliative care can help to anticipate care needs and improve patient outcomes and communication between care providers, patient, and families. A major barrier to effective transitional care is the current reimbursement system, which generally does not provide a financial incentive for collaboration across sites.
Despite the existence of palliative care programs, many researchers note that pain is prevalent in the older adult, and there are significant barriers to managing pain particularly in long-term care. Reasons cited for this include lack of training for clinicians in pain assessment and lack of knowledge about the pain experience of the cognitively impaired patient. A high incidence of arthritis, musculoskeletal conditions, and fractures among nursing home residents with cognitive impairment suggested that residents were experiencing unrecognized pain. Persistent pain was present in 49% of the nursing home residents (n = 21 380) in 10 states, and underrecognized and undertreated pain can result in impaired mobility, poor quality of life, and lowered satisfaction with care and depression as cited in several of these studies.
This quality improvement initiative explored the effectiveness of a palliative care program in improving patient outcomes and satisfaction. The program provided consultation visits by nurse practitioners during a continuous 6-month period to non–hospice-eligible patients 60 years or older. The nurse practitioners utilized the Clinical Practice Guidelines for Quality Palliative Care. This included collaboration with professional and family/friend caregivers in multiple settings, in order to ensure coordination, communication, and continuity of palliative care across sites of care.
The consult visits, provided by nurse practitioners during this study, were examined for their contribution to patient comfort, satisfaction, and smooth care transitions. The research questions were as follows:
How did patients rate their satisfaction with the care provided during the consult?
How did the patient or family rate the patient's comfort?
What were the patient outcomes after the consult visit(s)?