Development and evaluation of a mix-method intervention involving training and a new consultation model for patients with palliative care needs in primary care – Before-After Study
Carlos Seiça Cardoso, Filipe Prazeres, Barbara Gomes
Keywords: Primary Care, Palliative Care, Symptoms burden, Complex intervention, Before-After
Background:
There is some evidence that when General practitioners (GPs) are involved in caring for people with palliative care (PC) needs, PC delivery may be more efficient. We have developed a two-tiered intervention for patients with PC needs in primary care.
Research questions:
Can the developed intervention have impact on physical symptom burden (PhySB), psychological symptom burden (PsySB) and communication/practical issues (CPI)?
Method:
A before-after study is ongoing. A sample size of 53 patients patients was estimated (power of 80%, type I error of 5%, medium effect size of 0.5, 35% attrition rate). The intervention consists of training in PC and application of a newly consultation model (medical consultation every 3 weeks for 12 weeks). The primary outcome is PhySB, self-reported using the Integrated Palliative Outcome Scale patient version (IPOS-p) between T0w and T12w. Secondary outcomes include PsySB and CPI. The IPOS-p is a self-reported scale to identify the main concerns of PC patients. Items target specific symptoms/issues and are rated in 5-point Likert scales. Each of the 10 physical symptoms, psychological symptoms and communication/practical issues were linearly converted to a scale from 0 to 100, where higher scores correspond to more severe outcomes.
Results:
53 patients were recruited and 33 have completed the intervention and all outcome measurements. All patients will complete the intervention by February 2023. The recruited patients have a mean age of 72,53 (min 37, max 96); 54,7% female; 21 have advanced cancer, 10 chronic kidney disease V/VI, 16 chronic heart failure NYHA III/IV and 6 chronic obstructive pulmonary disease III/IV. Preliminary analysis shows a statistically significant reduction in PhySB (T0mean=184,85; T12=113,64; mean dif 71,21; IC95) and in PsySB (T0=128,03; T12=92,42; mean dif 35,61; IC95).
Conclusions:
Preliminary results indicate the intervention may have an impact on reducing symptom burden and it could be transferred to other countries with similar settings.
Points for discussion:
Primary care involved in (primary) palliative care
New consultation models and patient outcomes
Complex interventions in primary care research