Results of a Feasibility Pilot Pragmatic Trial Implementing Palliative Care in Skilled Nursing Facilities

Abstract

Background:

Seriously ill older adults are admitted for post-acute care in skilled nursing facilities (SNFs) for curative, rehabilitative treatments, yet experience high rates of re-hospitalization, and death. The primary palliative care in post-acute care (PPC-PAC) intervention is an evidence-based approach designed to help people with serious illness align treatment plans with goals of care, optimize quality of life, and improve satisfaction with their care.

Objectives:

To conduct a preliminary study and evaluate the feasibility of implementing the PPC-PAC intervention in the post-acute care SNF setting.

Design

: Two-group, multisite feasibility pilot pragmatic clinical trial with a non-equivalent design.

Measurements:

Primary outcome measures—eligibility, enrollment, and data collection rates; consultation satisfaction; and fidelity. Effectiveness outcome measure—quality of life using the Palliative Outcomes Scale version 2.

Results:

Close to 70% of those who were eligible and approached by the study team (45/65) enrolled in the trial throughout 12 SNFs in the Northeast and Mid-Atlantic United States. Thirty-five were enrolled from intervention sites; 10 were enrolled from control sites (usual care). Most participants (80%) expressed general satisfaction with PPC-PAC, and 90% of clinicians implemented the PPC-PAC intervention as intended. At 21 days follow-up, there were no significant differences in effectiveness outcomes.

Conclusion:

Implementation of the PPC-PAC intervention proved to be feasible and acceptable among older adults and clinicians. Future research should focus on testing the effectiveness of PPC-PAC and explore strategies for optimal intervention implementation and SNF staff engagement in the post-acute care setting.