Saturday, 15 January 2005 - 12:00 PM

This presentation is part of: Poster Session II

Effects of a Randomized Trial of an Advanced Illness Coordinated Care Program on Patients and Surrogates

Shortcomings in physiological, psychological, spiritual and practical domains of end-of-life (EOL) care for patients with advanced illness have been well documented, and knowledge about the effectiveness of care strategies to address these shortcomings is limited. The current study evaluated a new program designed to improve care delivery for patients with advanced illness (AI) and EOL care planning, increase patient involvement in shared decision-making, and improve communication between patients, families, and health care professionals. This clinical trial was conducted at six national sites and involved 253 patients with advanced illnesses (cancer, COPD and CHF) and 137 of their surrogates randomly assigned to an Advanced Illness Care Coordination Program (AICCP) or to a comparison group receiving usual care. AICCP participants met with an Advanced Illness Care Coordinator for approximately six sessions. AICCP provided counseling, education, and assistance in coping with advanced illness and coordinating AI/EOL care. AICCP focused on improvement of patient/family/provider communication about a variety of AI/EOL topics, including values clarification, improvement of illness understanding, advance planning, preparing surrogates, spiritual/emotional support, use of pain assessment guides, and assistance with practical issues related to living with advanced illness (e.g. financial issues, hospice services). At study enrollment and three months post-enrollment, patients and surrogates completed measures of satisfaction with health care and provider communication. Medical records of a subset of patient decedents were examined for development of advanced directives (ADs) and consistency of medical care with patient preferences in ADs. Care Coordinator’s activity logs were used to estimate the cost per case of providing AICCP. Medical costs from six months pre-enrollment through six months post-enrollment were abstracted and compared for patients at three study sites where total cost data was accessible. Results indicated that AICCP significantly increased patient satisfaction with health care and provider communication, while surrogates of patients in the AICCP program reported fewer problems with the emotional and spiritual support from providers. At three and six months post-enrollment, AICCP participants were significantly more likely than usual care participants to have filed at least one AD, and displayed more continuous advance planning as reflected by significantly greater numbers of documented ADs and DNR/DNI orders. Only two cases received end-of-life care were judged inconsistent with ADs, so no differences between AICCP and usual care could be identified. Although AICCP costs were 13% lower than usual care, the difference was not significant. The cost of the program delivery was $452.12 per case. The study concluded that AICCP improves patients’ satisfaction with health care and provider communication, while AICCP surrogates report fewer problems with emotional and spiritual support from providers. AICCP also increases the likelihood that patients will formulate and document ADs and accept DNRs/DNIs. The cost of AICCP was 2.5% of total patient costs and represents a low-cost means to help physicians comprehensively meet the extensive needs of seriously ill patients in medical, psychological, spiritual and practical domains of care.

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