Feasibility and effectiveness of a two-tiered intervention involving training and a new consultation model for patients with palliative care needs in primary care: A before-after study

Abstract

Background: Evidence suggests that involving General Practitioners in the care of patients with palliative care needs may improve patient outcomes. Aim: To evaluate whether a two-tiered intervention involving training in palliative care and a new consultation model in primary care for patients with palliative care needs is feasible and could reduce patients’ symptom burden. Design: Before-after study including an internal pilot. Setting/participants: Nine general practitioners working in a health region in Portugal and 53 patients with palliative care needs from their patient lists were recruited. General Practitioners received training in palliative care and used a new primary palliative care consultation model, with medical consultations every 3 weeks for 12 weeks. The primary outcome was physical symptom burden, self-reported using the Integrated Palliative care Outcome Scale (IPOS) patient version (min.0–max.1000). Secondary outcomes included emotional symptoms (min.0–max.400) and communication/practical issues (min.0–max.300). Results: Of the 35/53 patients completed the 12-week intervention (mean age 72.53 years, SD = 13.45; 54.7% female). All had advanced disease: one third had cancer ( n = 13), one third had congestive heart failure ( n = 12); others had chronic kidney disease and chronic obstructive pulmonary disease. After the 12 weeks of intervention, there was a reduction in physical symptom burden [mean difference from baseline of 71.42 (95%CI 37.01–105.85) with a medium-large effect size (0.71], and in emotional symptom burden [mean difference 42.86 (95%CI 16.14–69.58), with a medium effect size (0.55)]. No difference was found for communication/practical issues. Conclusions: Our intervention can be effective in reducing patients’ physical and emotional symptoms. Trial registration: ClinicalTrials.gov ID – NCT05244590. Registration: 14th February 2022.