OBJECTIVES

To determine whether inpatient palliative consultation services improve outcomes of care.

DESIGN

Retrospective telephone surveys conducted with family members of veterans who received inpatient or outpatient care from a Department of Veterans Affairs (VA) medical facility in the last month of life.

SETTING

Five VA Medical Centers or their affiliated nursing homes and outpatient clinics.

PARTICIPANTS

Veterans had received inpatient or outpatient care from a participating VA in the last month of life. One family member completed each survey.

MEASUREMENTS

The telephone survey assessed nine aspects of the care the patient received in his or her last month of life: the patient's well-being and dignity (4 items), adequacy of communication (5 items), respect for treatment preferences (2 items), emotional and spiritual support (3 items), management of symptoms (4 items), access to the inpatient facility of choice (1 item), care around the time of death (6 items), access to home care services (4 items), and access to benefits and services after the patient's death (3 items).

RESULTS

Interviews were completed with 524 respondents. In a multivariable linear regression model, after adjusting for the likelihood of receiving a palliative consultation (propensity score), palliative care patients had higher overall scores: 65 (95% confidence interval (CI)=62-66) versus 54 (95% CI=51-56; P<.001) and higher scores for almost all domains. Earlier consultations were independently associated with better overall scores (beta=0.003; P=.006), a difference that was attributable primarily to improvements in communication and emotional support.

CONCLUSION

Palliative consultations improve outcomes of care, and earlier consultations may confer additional benefit.