Palliative care training can improve patient outcomes

Healthcare workers who received palliative care training at six medical centers improved patient outcomes in four areas, according to a new study published in the Journal of General Internal Medicine.

Researchers with the Best Practices for End-of-Life Care for Our Nation's Veterans (BEACON), led by F. Amos Bailey of the Birmingham (Ala.) Medical Center, conducted a trial intervention at six Veterans Affairs Medical Centers, according to the study. As part of the trial, they introduced training on several processes associated with hospice care, including identifying dying patients, delivering the prognosis to patients and their families, and applying hospice care best practices to an inpatient environment.

After the intervention was put in place, researchers found moderate improvements in the following areas:

  • Increased orders for opioid medication for pain and shortness of breath;

  • More orders for benzodiazepine and antipsychotic medications used to treat agitation, anxiety and delirium;

  • Advance directives; and

  • Medications for rattling sounds when breathing or "death rattles."

However, the trials had no significant effect on do-not-resuscitate orders, restraints, intravenous lines or location of death, according to the study.

"We only die once, and therefore there is only one opportunity to provide excellent care to a patient in the last days of life," the researchers wrote. "The keys to excellent end-of-life care are recognizing the imminently dying patient, communicating the prognosis, identifying goals of care, and anticipating and palliating symptoms. Since it is not possible to predict with certainty which symptoms will arise, it is prudent to have a flexible plan ready."

A report last December from the Journal of Palliative Care found that palliative care adapted to individual patient needs cut emergency room visits and healthcare costs and improved overall care. However, a combination of current structural obstacles and the stigma from palliative care's association with end-of-life care prevent proper implementation, FierceHealthcare previously reported.

To learn more:
- here's the study abstract