Effects of an integrated palliative care pathway

The importance of connecting multidisciplinary palliative care services into integrated palliative care (pathways) is increasingly recognized. Early palliative care pathways, such as the Liverpool Care Pathway focused on the last days of life, and the process of dying within institutions.

Contemporary pathways widen their scope: first, they do not merely focus on the terminal phase, but aim for the early, proactive identification of the palliative phase including Advance Care Planning (ACP). Second, besides hospitals and nursing homes, they also aim to optimize primary palliative care.

They deal however with 2 problems: first, many pathways still not cover the full care cycle (primary, hospital, and pharmaceutical care), and are “moderately integrated” and second, evaluations of integrated, proactive palliative care pathways often measure limited outcomes.

This study presents an integrated, proactive palliative care pathway covering the complete cycle of care, and evaluates its effects using multiple outcomes. The intervention is a multidisciplinary, integrated palliative care pathway encompassing (among others) early identification of the palliative phase, multidisciplinary consultation and coordination, and continuous monitoring of outcomes.

The study published in JAMDA shows, that GPs act more proactively toward palliative patients. GPs report that palliative patients die more often at their preferred place of death. Relatives of included, deceased patients reported improvement in quality of dying, and more timely palliative care. Patients received more (intensive) primary care, less unexpected care during out-of-office hours, and more often received hospital care in the form of day care.

It is concluded, that an integrated palliative care pathway improves a variety of clinical outcomes important to patients, their families, physicians, and the health care system. The integration of palliative care into multidisciplinary, proactive palliative care pathways, is therefore a desirable future development.      

For more details see: Groenewoud AS et al.  https://doi.org/10.1016/j.jamda.2020.10.025

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