Delivery strategies to optimize resource utilization and performance status for patients with advanced life-limiting illness: Results from the "Palliative Care Trial" [ISRCTN81117481]

Amy Abernethy, David Currow, Tania Shelby-James, Debra Rowett, Frank May, G Samsa, Roger Hunt, Helena Williams, Adrian Esterman, Paddy Phillips

    Research output: Contribution to journalArticlepeer-review

    67 Citations (Scopus)


    Context: Evidence-based approaches are needed to improve the delivery of specialized palliative care. Objectives: The aim of this trial was to improve on current models of service provision. Methods: This 2 × 2 × 2 factorial cluster randomized controlled trial was conducted at an Australian community-based palliative care service, allowing three simultaneous comparative effectiveness studies. Participating patients were newly referred adults, experiencing pain, and who were expected to live >48 hours. Patients enrolled with their general practitioners (GPs) and were randomized three times: 1) individualized interdisciplinary case conference including their GP vs. control, 2) educational outreach visiting for GPs about pain management vs. control, and 3) structured educational visiting for patients/caregivers about pain management vs. control. The control condition was current palliative care. Outcomes included Australia-modified Karnofsky Performance Status (AKPS) and pain from 60 days after randomization and hospitalizations. Results: There were 461 participants: mean age 71 years, 50% male, 91% with cancer, median survival 179 days, and median baseline AKPS 60. Only 47% of individuals randomized to the case conferencing intervention received it; based on a priori-defined analyses, 32% of participants were included in final analyses. Case conferencing reduced hospitalizations by 26% (least squares means hospitalizations per patient: case conference 1.26 [SE 0.10] vs. control 1.70 [SE 0.13], P = 0.0069) and better maintained performance status (AKPS case conferences 57.3 [SE 1.5] vs. control 51.7 [SE 2.3], P = 0.0368). Among patients with declining function (AKPS <70), case conferencing and patient/caregiver education better maintained performance status (AKPS case conferences 55.0 [SE 2.1] vs. control 46.5 [SE 2.9], P = 0.0143; patient/caregiver education 54.7 [SE 2.8] vs. control 46.8 [SE 2.1], P = 0.0206). Pain was unchanged. GP education did not change outcomes. Conclusion: A single case conference added to current specialized community-based palliative care reduced hospitalizations and better maintained performance status. Comparatively, patient/caregiver education was less effective; GP education was not effective.

    Original languageEnglish
    Pages (from-to)488-505
    Number of pages18
    JournalJournal of Pain and Symptom Management
    Issue number3
    Publication statusPublished - Mar 2013


    • adult
    • case conference
    • evidence-based service delivery model
    • hospice
    • pain
    • Palliative care
    • patient and caregiver education
    • physician education
    • specialized palliative care


    Dive into the research topics of 'Delivery strategies to optimize resource utilization and performance status for patients with advanced life-limiting illness: Results from the "Palliative Care Trial" [ISRCTN81117481]'. Together they form a unique fingerprint.

    Cite this