An integrated geriatric and palliative care model may improve patient satisfaction for older patients

1. In this single-centre prospective cohort study, development of a Swedish Palliative Care Guide to improve integrated geriatric and palliative care medicine was found to significantly improve patient satisfaction with care although no differences were found in other outcomes such as health-related quality or symptom burden. 

Evidence Rating: 1 (Excellent) 

The overall proportion of older adults in the world population continues to increase, and with this comes more individuals affected by multimorbidity, cognitive decline, and frailty. The integration of geriatric medicine and palliative medicine (coined as geriatric palliative care) has been proposed as a way to increase patient-centredness of care, decrease symptom burdens, and increase informed decision-making. The Swedish Palliative Care Guide (S-PCG) was designed to provide interprofesional guidance for evidence-based and patient-centred palliative care, independent of diagnosis, healthcare setting, and remaining lifespan. The current study aimed to evaluate the effect of using the S-PCG on patient satisfaction, health-related quality of life, symptom burden, ad next-of-kin satisfaction. This study was divided into three phases. First, the pre-intervntion phase where patient care was assessed without the S-PCG framework. Second, teaching the staff and clinical implementation of S-PCG. Third, the intervention phase, where patients were consecutively included as S-PCG was in clinical use. Adults above the age of 65 without evidence of cognitive impairment or a COVID-19 diagnosis were included if they were in hospital for five or more days during either the pre-intervention or intervention periods. In 9 of 10 questions measuring satisfaction with care, results were significantly better in the intervention group (Ps < 0.001 to 0.023). Next of kin also rates their satisfaction with the hospitalization significantly better after the intervention was implemented (P < 0.01). Discharge quality was largely unchanged. No significant differences were noted for health-related quality or symptom burden pre- and post-intervention. These effects were seen after a short hospital stay and lasted several weeks after discharge. While the study was strong in that it had many participants with a high response rate, one limitation is the fact that hospital stays were relatively short, limiting the potential benefits on symptom burden. 

Click to read the study in PLOSONE

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