JAMA network open · 2025
Palliative Video Consultation and Symptom Distress Among Rural Inpatients: A Randomized Clinical Trial.
СтатьяРандомизированное исследованиеМногоцентровое исследованиеПоддержка NIH: внешняя программаНазвание и аннотация: Перевод в очереди
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Bakitas Marie A, Gazaway Shena, Underwood Felicia, Ekelem Christiana, Heard Vantrice T, Kennedy Richard, Azuero Andres, Tucker Rodney, McCammon Susan, Hauser Joshua M, McElwain Lucas, Elk Ronit
Аннотация
IMPORTANCE: Palliative care has been shown to improve important patient outcomes but is rarely available in small or rural hospitals.
OBJECTIVE: To assess whether culturally based palliative care video consultation could improve symptom distress compared with usual inpatient care without palliative care.
DESIGN, SETTING, AND PARTICIPANTS: Recruitment for this multisite, single-blind randomized clinical trial occurred from July 20, 2020, to December 20, 2023; data collection was completed on January 15, 2024. A community-aided approach was used to recruit inpatients from 3 rural hospitals lacking palliative care services in Alabama, Mississippi, and South Carolina. Self-identified non-Hispanic Black or African American and non-Hispanic White adults aged 55 years or older admitted with a serious chronic illness and a willing caregiver were invited to participate. Randomization was stratified by site and race.
INTERVENTIONS: Participants were randomized 1:1 to Community Tele-Pal, culturally based video consultation by a palliative care specialist followed by research coordinator (RC) contacts 3 and 6 days after video consultation (intervention arm), or to routine hospital care (control arm).
MAIN OUTCOMES AND MEASURES: The primary outcome was the between-group difference in the change in patient-reported symptom distress from baseline to day 7, assessed by the Edmonton Symptom Assessment Scale (ESAS; range, 0-90; lower scores indicate lower symptom distress). Secondary outcomes were quality of life (QOL; Patient-Reported Outcomes Measurement Information System global physical and mental health mean T scores), resource use (emergency department visits and hospital readmissions), and an exploratory outcome of feeling heard and understood.
RESULTS: A total of 209 patients were randomized (104 to usual care; 105 to the intervention); mean (SD) age was 73.3 (8.3) years, 120 (57.4%) were female, 58 (27.8%) were Black or African American, 157 (75.1%) were retired, and 75 (35.9%) had a Palliative Performance Scale score less than 70% (indicating need for functional assistance). On day 7, the mean (SE) ESAS score change from baseline was -11.4 (1.5) points in the intervention group and -7.3 (1.5) points in the control group; the between-group difference in change in ESAS scores was not statistically significant (Westfall d, -0.28; 95% CI, -0.56 to 0.01; P = .055). The mean (SE) day 7 between-group difference in ESAS score of -4.0 (1.8) points met the criteria for a minimal clinically important difference of 3 to 4 points. No between-group differences were observed for QOL, resource use, or feeling heard and understood.
CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, the intervention was not associated with reduced symptom distress at day 7 vs baseline or with improved QOL or reduced resource use compared with usual care. However, the between-group difference in the ESAS score met the criteria for a minimal clinically important difference of 3 to 4 points. Palliative video consultation to reduce health care inequities for hospitalized rural-dwelling individuals may warrant further investigation.
TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03767517.
OBJECTIVE: To assess whether culturally based palliative care video consultation could improve symptom distress compared with usual inpatient care without palliative care.
DESIGN, SETTING, AND PARTICIPANTS: Recruitment for this multisite, single-blind randomized clinical trial occurred from July 20, 2020, to December 20, 2023; data collection was completed on January 15, 2024. A community-aided approach was used to recruit inpatients from 3 rural hospitals lacking palliative care services in Alabama, Mississippi, and South Carolina. Self-identified non-Hispanic Black or African American and non-Hispanic White adults aged 55 years or older admitted with a serious chronic illness and a willing caregiver were invited to participate. Randomization was stratified by site and race.
INTERVENTIONS: Participants were randomized 1:1 to Community Tele-Pal, culturally based video consultation by a palliative care specialist followed by research coordinator (RC) contacts 3 and 6 days after video consultation (intervention arm), or to routine hospital care (control arm).
MAIN OUTCOMES AND MEASURES: The primary outcome was the between-group difference in the change in patient-reported symptom distress from baseline to day 7, assessed by the Edmonton Symptom Assessment Scale (ESAS; range, 0-90; lower scores indicate lower symptom distress). Secondary outcomes were quality of life (QOL; Patient-Reported Outcomes Measurement Information System global physical and mental health mean T scores), resource use (emergency department visits and hospital readmissions), and an exploratory outcome of feeling heard and understood.
RESULTS: A total of 209 patients were randomized (104 to usual care; 105 to the intervention); mean (SD) age was 73.3 (8.3) years, 120 (57.4%) were female, 58 (27.8%) were Black or African American, 157 (75.1%) were retired, and 75 (35.9%) had a Palliative Performance Scale score less than 70% (indicating need for functional assistance). On day 7, the mean (SE) ESAS score change from baseline was -11.4 (1.5) points in the intervention group and -7.3 (1.5) points in the control group; the between-group difference in change in ESAS scores was not statistically significant (Westfall d, -0.28; 95% CI, -0.56 to 0.01; P = .055). The mean (SE) day 7 between-group difference in ESAS score of -4.0 (1.8) points met the criteria for a minimal clinically important difference of 3 to 4 points. No between-group differences were observed for QOL, resource use, or feeling heard and understood.
CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, the intervention was not associated with reduced symptom distress at day 7 vs baseline or with improved QOL or reduced resource use compared with usual care. However, the between-group difference in the ESAS score met the criteria for a minimal clinically important difference of 3 to 4 points. Palliative video consultation to reduce health care inequities for hospitalized rural-dwelling individuals may warrant further investigation.
TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03767517.