Do family meetings for hospitalised palliative care patients improve outcomes and reduce health care costs? A cluster randomised trial.

2021-01

Hudson, Peter

Girgis, Afaf

Thomas, Kristina

Philip, Jennifer

Currow, David C

Mitchell, Geoffrey

Parker, Deborah

Liew, Danny

Brand, Caroline

Le, Brian

Moran, Juli A

Palliative

cost benefit analysis

emotional distress

family caregivers

health care economics

health related quality of life

intervention study

pragmatic clinical trials

randomised clinical trial

Journal Article

0000-0001-5891-8197

0000-0002-0214-1865

0000-0003-1988-1250

10.1177/0269216320967282

Family meetings facilitate the exploration of issues and goals of care however, there has been minimal research to determine the benefits and cost implications. To determine: (1) if family caregivers of hospitalised patients referred to palliative care who receive a structured family meeting report lower psychological distress (primary outcome), fewer unmet needs, improved quality of life; feel more prepared for the caregiving role; and receive better quality of end-of-life care; (2) if outcomes vary dependant upon site of care and; (3) the cost-benefit of implementing meetings into routine practice. Pragmatic cluster randomised trial involving palliative care patients and their primary family caregivers at three Australian hospitals. Participants completed measures upon admission (Time 1); 10 days later (Time 2) and two months after the patient died (Time 3). Regression analyses, health utilisation and process evaluation were conducted. 297 dyads recruited; control (n = 153) and intervention (n = 144). The intervention group demonstrated significantly lower psychological distress (Diff: -1.68, p < 0.01) and higher preparedness (Diff: 3.48, p = 0.001) at Time 2. No differences were identified based on quality of end of life care or health utilisation measures. Family meetings may be helpful in reducing family caregiver distress and enhancing their preparedness for the caregiving role and it appears they may be conducted without increased hospital health utilisation impacts; although opportunity costs need to be considered in order to routinely offer these as a standardised intervention. Additional health economic examination is also advocated to comprehensively understand the cost-benefit implications. Australian and New Zealand Clinical Trials Registry ACTRN12615000200583.

link

Palliative Medicine 2021; 35(1): 188-199

Palliative Medicine