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Assessing the effectiveness of a hospital palliative care team
John E Ellershaw
Pain Relief Research Unit, King's College Hospital, London
Sue J Peat
Pain Relief Research Unit, King's College Hospital, London
Lesley C Boys
Pain Relief Research Unit, King's College Hospital, London
A prospective study was carried out of 125 hospital inpatients with malignant disease, referred to the King's College Hospital advisory palliative care team. A palliative care assessment (PACA) tool was developed in order to assess the outcome of interventions made within two weeks of referral with regard to: symptom control, change in the patients' and their relatives' insight regarding diagnosis and prognosis, and facilitation of patient placement. Reliability was assessed by cross-observer analysis, and validity by comparison with data obtained using the McCorckle symptom distress scale in a separate group of hospice inpatients.
At initial assessment, the commonest symptom was pain, as reported by 74% of patients. One-third of the patients were unsure of their diagnosis and placement had not been decided in 61 %. In total, the team undertook 245 pharmacological interventions for symptom control, 165 interventions regarding insight and 114 interventions concerning placement. Analysis of the data showed statistically significant improvements in pain (p < 0.001), nausea (p < 0.009), insomnia (p < 0.004), anorexia (p < 0.001) and constipation (p < 0.02). Discussion regarding diagnosis significantly changed the insight of patients (p < 0.001) and relatives (p < 0.02). Appropriate placement was assisted by interventions undertaken by the team.
This study shows that a hospital palliative care team is effective at improving symptom control, facilitates understanding of the diagnosis and prognosis, and contributes to the appropriate placement of patients.
Key Words: cancer care facilities • palliative care service • hospital (non-MeSH) • palliative treatment • programme evaluation • terminal care
Palliative Medicine, Vol. 9, No. 2,
145-152 (1995)
DOI: 10.1177/026921639500900205
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