Despite the broad development of hospital-based palliative care teams (HBPCT), their effectiveness is still questionable and there is a lack of high-grade evidence supporting their benefit
Aims: To evaluate effectiveness of HB-PCT assistance of in-patients at three public hospitals from Buenos Aires, Argentina.
Methods: Adapted Palliative Care Assessment (PACA) tool was used to systematically assess outcomes regarding symptom control, insight about diagnosis/prognosis from patients and carers and facilitation of placement after discharge during two consecutive weeks. Wilcoxon paired rank test was used to compare data at each evaluation with baseline values and crossobserver analysis to test realiability.
Results: 142 patients (male 50%) were evaluated; mean age 61.5y (r = 22 - 89); days of admission before palliative care advice = 6 (r = 0 - 45). Pain of every grade of intensity decreased significantly between day 0 and 3 (z:- 8.254; p<0.001) as well as pain dominating daily life. Seven other symptoms measured significantly decreased from baseline to second evaluation (p<0.001 - 0.05). No further significative improvement was observed for most of the symptoms. Patients insight about diagnosis and prognosis (day 0 and 3) increased from 81% to 92% (p<0.0001) and 72% to 89% (p< 0.0001). Family insight followed similar trends. Complete organization of care at discharge improved from 3.5% (baseline) to 55% of patients at the end of the study. Inter-rater reliability was high (kappa = 0.94). Conclusions: HB-PCT allowed: a) control of most of the symptoms after 72h of first evaluation; b) better insight from patients/carers and c) improved planning of care after discharge. The results support the effectivity of HBPCT. Studies in three other public hospitals without palliative care assistance are on developing and will serve as control group.