Impact of Specialist Palliative Care on End-of-Life Care Planning for Patients with ALS
Christi Lero1, Annabelle Yang2, Elyse Everett2, Karla Washington2
1Brown School of Social Work, Washington University in St. Louis, MO, 2Department of Medicine, Washington University School of Medicine, St. Louis, MO
Objective:
This exploratory study aimed to assess the impact of specialist palliative services on end-of-life care provided to patients with amyotrophic lateral sclerosis (ALS).
Background:
ALS is a progressively debilitating, fatal disease of motor neuron degeneration. Care for patients with ALS relies on a multidisciplinary team of healthcare professionals that may include palliative care specialists, who provide expertise in pain and symptom management, supporting caregivers, coping with the emotional impact of ALS, and defining goals of care across the disease trajectory. Few studies have examined the impact of specialist palliative care for patients with ALS, resulting in an underdeveloped evidence base.
Design/Methods:
A retrospective chart review was completed to compare patients with ALS who received traditional multidisciplinary care (n=65) and those who received specialist palliative care in addition to traditional multidisciplinary care (n = 94) with regard to (1) receipt of hospice care (yes/no), (2) documentation of power of attorney or equivalent (yes/no), and (3) documentation of goals of care discussion (yes/no). Chi square test for independence was conducted to examine outcomes.
Results:
This cohort consisted of 159 patients whose deaths occurred between 1/1/20-6/30/22. Compared to patients with ALS who did not receive specialist palliative care, a greater proportion of those with palliative care involvement received hospice care (48% vs 79%, p<0.001), had documented power of attorney or equivalent (49% vs 72%, p=0.005), and had documented goals of care discussions (40% vs 91%, p<0.001).
Conclusions:
The involvement of specialist palliative care services improves end-of-life care outcomes for patients with ALS in terms of higher rates of hospice enrollment, documented power of attorney, and documented goals of care discussion.