- Adding outpatient palliative care to standard care improves outcomes among patients with Parkinson’s disease and related disorders having at least moderate need for palliation.
Why this matters
- High disease morbidity, QoL effect for patients and caregivers.
- At 6 months, palliative care vs standard care alone yielded:
- Improved QoL (mean, +0.66 vs −0.84; P=.009).
- Trend toward greater reduction in caregiver burden (mean, −2.28 vs −1.08; P=.06).
- Palliative care also netted significantly more favorable changes in:
- Nonmotor symptom burden,
- Motor symptom severity,
- Completion of advance directives,
- Caregiver anxiety, and
- Caregiver burden at 12 months.
- Benefits greater for patients with higher palliative care needs.
- Editorial: "Rather than focusing on readily discernible motor signs, screening is best performed based on identifying actual palliative care needs," using established instruments that the authors used in this study.
- Randomized controlled trial: 210 patients with Parkinson’s disease, related disorders having moderate to high palliative care needs; 175 caregivers.
- Randomization: standard care plus outpatient integrated palliative care (visits in person or by telemedicine every 3 months) vs standard care alone.
- Main outcomes: changes in QoL (Quality of Life in Alzheimer Disease scale), caregiver burden (Zarit Burden Interview) at 6 months.
- Funding: Patient-Centered Outcomes Research Institute.
- Generalizability to nonacademic settings, populations.
- Dilution of benefit because of care available to standard care group.
- Enrollment bias toward patients more interested in palliative care.
- Bias in self-reported outcomes.