Lessons From the Palliative Care Trial: Commentary on Abernethy et al.

Abstract

The study by Abernethy et al. is highly important because it is the world’s largest palliative care trial. It delivers valuable recommendations for palliative care practice and confirms the importance of early referral to palliative care. It also shows that high-quality randomized controlled trials of communitybased health service interventions are feasible. Three interventions were evaluated: 1) a single case conference between the patient’s general practitioner (GP) (or primary care physician in North American terms) and the specialist palliative care team; 2) academic detailing on palliative pain relief delivered to a specific patient’s GP; and 3) education interventions on pain and other symptom management provided to the patient and primary carer, delivered by palliative care nurses. Only patients who survived 60 days or more were analyzed for evidence of intervention effects. A single case conference reduced hospitalization rates by 0.5 per patient. A similar but smaller impact was noted for patient/carer interventions. Furthermore, case conferences maintained a 10% improved performance status compared with normal care from 60 days until death. The greatest benefit in terms of performance status occurred when the Australian Karnofsky Performance Scale was greater than 70, that is, when the patient could not manage without help. The patient/carer education delivered significant but smaller