Parkinson’s disease outcomes better with integrated outpatient palliative care

  • Kluger BM & al.
  • JAMA Neurol
  • 10 Feb 2020

  • curated by Susan London
  • Clinical Essentials
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Takeaway

  • Adding outpatient palliative care to standard care improves outcomes among patients with Parkinson’s disease and related disorders having at least moderate need for palliation.

Why this matters

  • High disease morbidity, QoL effect for patients and caregivers.

Key results

  • At 6 months, palliative care vs standard care alone yielded:
    • Improved QoL (mean, +0.66 vs −0.84; P=.009).
    • Trend toward greater reduction in caregiver burden (mean, −2.28  vs −1.08; P=.06).
  • Palliative care also netted significantly more favorable changes in:
    • Nonmotor symptom burden,
    • Motor symptom severity,
    • Completion of advance directives,
    • Caregiver anxiety, and
    • Caregiver burden at 12 months.
  • Benefits greater for patients with higher palliative care needs.

Expert comment

  • Editorial: "Rather than focusing on readily discernible motor signs, screening is best performed based on identifying actual palliative care needs," using established instruments that the authors used in this study.

Study design

  • Randomized controlled trial: 210 patients with Parkinson’s disease, related disorders having moderate to high palliative care needs; 175 caregivers.
  • Randomization: standard care plus outpatient integrated palliative care (visits in person or by telemedicine every 3 months) vs standard care alone.
  • Main outcomes: changes in QoL (Quality of Life in Alzheimer Disease scale), caregiver burden (Zarit Burden Interview) at 6 months.
  • Funding: Patient-Centered Outcomes Research Institute.

Limitations

  • Generalizability to nonacademic settings, populations.
  • Dilution of benefit because of care available to standard care group.
  • Enrollment bias toward patients more interested in palliative care.
  • Bias in self-reported outcomes.