Palliative Care in a Community-Based Serious-Illness Care Program.

Abstract

<b><i>Background:</i></b> Although community-based serious-illness care (CBSC) is an innovative care model, it is unclear to what extent CBSC addresses palliative care needs, particularly for those patients near death. <b><i>Objectives:</i></b> To evaluate palliative care services of a CBSC program. <b><i>Design:</i></b> Retrospective chart reviews. <b><i>Setting/Subjects:</i></b> Patients enrolled in a CBSC program in central North Carolina. <b><i>Measurement:</i></b> Descriptive statistics of palliative care needs and services, such as symptom management, psychosocial support, and advance care planning (ACP), for survivors and decedents. <b><i>Results:</i></b> Patients were seen in an 18-month time frame (<i>n</i> = 159). Mean enrollment in the program was 261.1 days (standard deviation 180.6). Patients' average age was 70 years, 56% were female, and 33% were black. Patients' most frequent comorbidities were dementia (32%), heart failure (32%), and diabetes (28%). Fifty patients (31%) died during the study period. Clinicians most frequently screened for pain (70%), constipation (57%), and dyspnea (57%). Of those screened positive, clinicians most frequently treated pain (92%), anxiety (84%), and constipation (83%). Among the 54% who screened positive for psychosocial distress, 82% received support. Clinicians screened 22% for spiritual needs; 4% received spiritual care. Among decedents, 66% were enrolled in hospice; 14% died in in-hospital. Decedents were more likely than survivors to have ACP (34% vs. 18%, <i>p</i> = 0.03) and a primary goal of comfort (40% vs. 12%, <i>p</i> < 0.01). <b><i>Conclusions:</i></b> A CBSC program provided palliative care services comparable with other home-based palliative care programs. Although the CBSC program does not address all domains of palliative care, it provided most with symptom management, psychosocial support, and ACP.