From 2015 to 2017, a group of researchers led by Benzi M. Kluger, MD, at the University of Colorado enrolled patients into a study to see the impact this type of care can have on patients with Parkinson’s disease. The article published afterwards is about the comparison of integrated outpatient Palliative Care (PC) with standard care in patients with Parkinson Disease and Related Disorders (PDRD). According to Kluger, in one year they have randomized three different care centers and followed the patients. A study showed that 584 patients with PDRD were referred to the study. Patients with PDRD and moderate to high PC are eligible for the research, except for the patients who had urgent PC needs and they were unable or willing to follow the study protocol.
The patients were randomized using a 1:1 ratio and stratified by site, which is the presence of a caregiver. The outpatient integrated PC are administered by a neurologist, social worker, chaplain, and nurse using PC checklists while the standard care was provided by a neurologist and a primary care practitioner. Although all the academic teams worked within integrated PC models, they are varied in the clinic flow and their use of the palliative medicine specialist.
The patients assigned to the PC intervention group received outpatient PC visits every 3 months for 1 year, Physician and other health care visits for standard care were recorded but not mandated. While the patient and caregiver outcomes were recorded at baseline and every 3 months for 12 months. The primary outcomes were group differences in patient QoL and caregiver burden for 6 months.
Results and Discussion
Overall, the data shows that the intervention of palliative care with patients diagnosed with Parkinson’s has increased their quality of life numbers enough that the data can classify it as significant. Within the first half of this study that lasted 6 months, the quality of life for patients treated with standard care dropped by -.0.84 while the quality of life for patients who had the palliative care intervention increased by 0.66. As for the ZBI scores the standard care group had a decrease of -1.08 while the palliative care group decreased by -2.28. They also found that there was better symptom burden which is when symptoms place a physiologic burden on patients and producing multiple negative, physical, and emotional patient responses. For the standard care group there was a decrease of -0.45 while the palliative intervention group had a decrease of -6.81. The conclusion they were able to reach with these numbers suggest that the intervention of palliative care for people with Parkinson’s and other related disorders is beneficial and should be optimized as much as possible for both current and future patients. Some advantages of the paper were being able to gain patients through this being an academic setting, however the flip side of that would be the question of whether this care is able to be implemented in outside environments. The population of the patients themselves was not diverse, which could have led to either intentional or unintentional bias in terms of receiving care. Patient-reported outcomes also hold the possibility of being biased as well. Doing more studies with a more diverse population and other care settings may improve the scope of these results to include a wider variety of people, and get more accurate data to apply for a larger scale of patients with Parkinson’s and other related diseases.
Reference:
Kluger, Benzi M. (May 2020). Comparison of Integrated Outpatient Palliative Care with Standard Care in Patients with Parkinson Disease and Related Disorders. JAMA Neurology, Volume 77, Number 5, pg. 551 -560.
