Early outpatient discussions about palliative care (PC) were associated with improved functionality while home-based prepalliative care delivered by nurse practitioners (NPs) lead to decreased health care utilization, according to results of 2 studies presented at the 2022 American Association of Nurse Practitioners (AANP) National Conference held June 21 to June 26, 2022, in Orlando, Florida.
In the first study, Paige Hickey, MSN, FNP-C, from Massachusetts College of Pharmacy and Health Sciences performed a systematic review of studies published between 2010 and 2021 on the topic of early vs late palliative care interventions. Referrals for palliative care often occur late in the disease process. Earlier discussions may improve patient perceptions during end-of-life and decrease health care utilization.
Hickey reported that outpatient palliative care discussions were associated with shorter hospital stays, improved functionality, and greater likelihood of meeting National Quality Forum standards compared with inpatient palliative care discussions. Similarly, earlier palliative care discussions were associated with increased survival rates and helped facilitate difficult end-of-life conversations with providers. Patients indicated they preferred earlier PC discussions and those who received outpatient discussions self-reported improved social activity, quality of life, and reduced symptoms.
NP-Led Home-Based Prepalliative Care Linked to Fewer Hospitalizations
In the second study, Denise Coppa, PhD, FNP-C, FAANP, FAAN, and Suzy Barcelos Winchester, MA, MSW, LCSW, from the University of Rhode Island College of Nursing conducted a quasi-experimental 2-group study between 2016 and 2020. Outcomes of patients (n=233) who received prepalliative home-based primary care (HBPC) from 3 NPs were compared with a matched comparator group (n=234) that received standard care in a clinic setting. All patients had a recent hospitalization and were considered high risk/high utilizers.
The mean age of patients in the intervention and control cohorts were 62.6 and 62.7 years, 68% and 68% were women, 61% and 58% had Medicare insurance, 49% and 40% had chronic pulmonary disease (P <.05), 20% and 12% renal disease (P <.05), and 17% and 9% had diabetes (P <.05), respectively.
The HBPC intervention facilitated more prepalliative advanced care discussions (55% vs 0.3%; P <.001), completion of do not resuscitate or intubate orders (22.4% vs 3%; P <.001), and medical orders for life sustaining treatment (17% vs 2%; P <.001) compared with standard care, respectively.
Despite having higher rates of chronic diseases, the HBPC cohort had fewer provider visits (mean, 7 vs 55; P <.001), hospitalizations (mean, 0.3 vs 0.7; P <.001), and emergency department visits (mean, 0.4 vs 0.7; P <.001). The intervention was associated with longer visit lengths, with 44% of visits lasting more than 45 minutes compared with 7% with standard care (P <.001).
Home-based palliative care delivered by NPs has the potential to save $26,049 in emergency department visits and $88,000 to $440,000 in hospitalizations annually, the study authors concluded.
Together, the findings from these 2 studies indicated that patients benefited from early palliative care discussions and that NPs could play a role in delivering HBPC by facilitating end-of-life discussions.
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Hickey P. Timing and location of palliative care discussion: does it matter? Presented at: AANP 2022; June 21-26, 2022; Orlando, Fl.
Coppa D, Winchester SB. Nurse practitioners in home based pre-palliative care demonstrate an innovative, value based approach to end of life care planning. Presented at: AANP 2022; June 21-26, 2022; Orlando, Fl.