The effect of palliative care on patient functioning

Abstract

Background: Palliative care is increasingly viewed as a care option that should not only be offered to patients very near the end of life. An important question is whether increased use of palliative care soon after a patient's referral will improve patient functioning, an aspect of quality of life.

Objectives: The aim of this study was to determine if increased use of palliative care is associated with increased patient functioning.

Methods: The Carolinas Palliative Care Database Consortium collects palliative care encounter data from a variety of providers, settings, and patients, and it measures patient functioning, allowing us to test the hypothesis that increased use of palliative care early in a patient's palliative care experience will improve patient functioning.

Results: After controlling for other factors that could explain patient functioning, we find that each additional palliative care visit during the first month of follow-up increases patient functioning measured using an area under the curve (AUC) approach (0.008 per visit, p=0.01). However, patient functioning as measured at the initial visit is a far stronger predictor of subsequent functioning (0.52, p<0.001) than are additional palliative care visits.

Conclusions: Increased use of palliative care was associated with improved patient functioning. This held true at very low as well as very high levels of initial functioning. The strongest predictor of subsequent patient functioning is their initial status. Accounting for patient-specific differences to precisely determine the impact of palliative care on patient functioning is difficult.

FIG. 1.

Operationalizing quality of life using an area under the curve (AUC) approach. Example: This patient has 5 visits in total. He has 2 visits within the first 30 days and 3 visits after 30 days. Here is how AUC gets calculated: Area 1=(0.6+0.4)*(55−30)/2=12.5 (Trapezoidal Rule); Area 2=(0.2+0.4)*(100−55)/2=13.5 (Trapezoidal Rule); Area 3=0.2*(120−100)=4 (Rectangle); Maximum possible area after 30 days=(120−30)*1=90; AUC=(area1+area2+area3)/(maximum area)=(12.5+13.5+4)/90=30/90=0.33.