Abstract
Context
Increasing evidence demonstrates the benefits of palliative care among individuals
with Parkinson's disease and related disorders (PDRD), but the critical components
that contribute to therapeutic effects are not well understood.
Objectives
To determine the specific items most responsive to a palliative care intervention
in PDRD and identify key correlates of improvement in patient and care partner outcomes.
Methods
The main trial was a pragmatic comparative effectiveness trial of outpatient integrated
palliative care compared to standard care among participants with PDRD (NCT02533921),
showing significantly higher patient QOL at six months and lower care partner burden
at 12 months. We used longitudinal regression models to analyze changes in subdomains
of patient QOL and care partner burden and Spearman correlations to evaluate key correlates
of change scores in patient and care partner outcomes. We performed a secondary analysis
of data from 210 patients and 175 care partners.
Results
Compared to controls, patients in the intervention reported greater improvement in
perceptions of the “self as a whole” at six months (coeff = 0.22, P < 0.05) and care partners reported greater reduction in stress, anger, and loss of
control at 12 months (coeff = -.40, -0.25, -0.31, P < 0.05). Positive change in numerous patient non-motor symptoms and grief correlated
with improved patient QOL, reduced patient anxiety, and increased care partner spirituality.
Alleviation of care partner anxiety and depression correlated with reduced care partner
burden.
Conclusion
Specific benefits of an integrated palliative approach in PDRD include improvement
in patient holistic self-impressions, care partner self-efficacy, and non-motor symptoms.
Key Words
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Article info
Publication history
Published online: January 30, 2022
Accepted:
January 22,
2022
Identification
Copyright
© 2022 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
