Pilot of Trigger-based Palliative Care Referral among Individuals with Parkinson Disease

Objective: To pilot the use of a trigger-based method for specialty Palliative Care referral in individuals with Parkinson disease (PD). Background: There is recognition of the benefit of specialty Palliative Care in PD. However, optimal methods to operationalize referral remain unclear. Oncology has explored the use of triggers (specific symptoms or events) to prompt referral to Palliative Care, but their use has not been assessed in PD. Design/Methods: We identified individuals for potential referral to Palliative Care using a trigger-based questionnaire (triggers: uncontrolled depression, pain, fatigue; ≥3 falls, ≥10 pounds weight loss, wheelchair bound) in a movement disorders clinic. Individuals who indicated the presence of a trigger and care partners were invited to enroll. We assessed: 1) barriers to referral and the proportion of individuals who saw a Palliative Care specialist; 2) changes in disease and care partner burden between baseline and 3 months following consultation; and 3) participant opinions of the intervention via qualitative interviews. Results: We identified 55 eligible respondents among 250 returned questionnaires (77.4% return rate). We enrolled 20 individuals with PD and 10 care partners; the most common reason for non-enrollment was limited perceived benefit. Among participants with PD, mean age was 66.1 years, mean disease duration 8.7 years. 13 participants completed ≥1 visit with Palliative Care. Reasons for not completing consultation included scheduling challenges (n=3), loss to follow-up (n=2), cost (n=1), death (n=1). There was no significant change in outcomes over 3 months. However, participants endorsed subjective benefit with improved symptom control, broadening the focus of their care, and facilitating advance care planning. Conclusions: A trigger-based questionnaire was feasible to screen for Palliative Care referral in PD, and those who underwent consultation indicated benefit. 17.0% of patients endorsed a trigger, but only 23.6% of eligible respondents completed consultation. Alternative methods to screen for palliative needs are likely required in PD. Disclosure: Dr. Tarolli has nothing to disclose. Dr. Zimmerman has nothing to disclose. Dr. Dorsey has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Roche; Sanofi; Clintrex; Olson Research Group, Inc.; Denali Therapetuics; Biogen; Abbvie; DeciBio; Prilenia. He has ownerships interests with Blackfynn and Grand Rounds. Dr. Dorsey has received personal compensation in an editorial capacity for Karger. Dr. Dorsey has received research support from Biogen; Pfizer; Biosensics; Abbvie.Dr. Horowitz has nothing to disclose. Dr. Kluger has nothing to disclose. Dr. Holloway has nothing to disclose.