Hanson, Laura C.Kistler, Christine E.Lavin, KyleGabriel, Stacey L.Ernecoff, Natalie C.Lin, Feng-ChangSachs, Greg A.Mitchell, Susan L.2018-11-202018-11-202018Hanson, L. C., Kistler, C. E., Lavin, K., Gabriel, S. L., Ernecoff, N. C., Lin, F.-C., … Mitchell, S. L. (2018). Triggered Palliative Care for Late-stage Dementia: a Pilot Randomized Trial. Journal of Pain and Symptom Management. https://doi.org/10.1016/j.jpainsymman.2018.10.494https://hdl.handle.net/1805/17799Context Persons with late-stage dementia have limited access to palliative care. Objective To test dementia-specific specialty palliative care triggered by hospitalization. Methods This pilot randomized controlled trial enrolled 62 dyads of persons with late-stage dementia and family decision-makers on admission to hospital. Intervention dyads received dementia-specific specialty palliative care consultation plus post-acute transitional care. Control dyads received usual care and educational information. The primary outcome was 60-day hospital or emergency department visits. Secondary patient and family-centered outcomes were patient comfort, family distress, palliative care domains addressed in the treatment plan, and access to hospice or community-based palliative care. Secondary decision-making outcomes were discussion of prognosis, goals of care, completion of Medical Orders for Scope of Treatment (MOST), and treatment decisions. Results Of 137 eligible dyads, 62 (45%) enrolled. The intervention proved feasible, with protocol completion ranging from 77% (family 2-week call) to 93% (initial consultation). Hospital and emergency department visits did not differ (intervention vs control, 0.68 vs 0.53 transfers per 60 days, p=0.415). Intervention patients had more palliative care domains addressed, and were more likely to receive hospice (25% vs 3%, p<0.019). Intervention families were more likely to discuss prognosis (90% vs 3%, p<0.001) and goals of care (90% vs 25%, p<0.001), and to have a MOST at 60-day follow-up (79% vs 30%, p<0.001). More intervention families made decisions to avoid re-hospitalization (13% vs 0%, p=0.033). Conclusion Specialty palliative care consultation for hospitalized patients with for late-stage dementia is feasible and promising to improve decision-making and some treatment outcomes.enPublisher Policydementiapalliative carerandomized trialArticle