Characteristics associated with Unstable phases in palliative care services

People diagnosed with a life-limiting illness can experience episodes of sudden worsening of symptoms, often occurring in conjunction with physical deterioration. In specialist palliative care in Australia, these events are often referred to as an Unstable phase. Reducing the occurrence of this phase involves both comprehensive patient assessment and effective anticipatory care planning and medication prescribing. To date, there is no published literature on the characteristics associated with a palliative care Unstable phase. The aim of the study was to explore the patient and care characteristics associated with the start of an Unstable phase for patients receiving care from Australian specialist palliative care services from January 1, 2013, to December 31, 2015. This was a population based study using prospectively collected data from people diagnosed with a life-limiting illness and receiving specialist palliative care from services participating in the Palliative Care Outcomes Collaboration (PCOC) quality improvement program. Data were analysed for 79,842 patients, those receiving palliative care in a community setting (n = 37,745; 44.6%) and those receiving palliative care in an inpatient setting (n = 46,940; 55.4%). The results revealed that an Unstable phase was associated with a higher level of symptom distress relative to a Stable or Deteriorating phase, and particularly for patients receiving care in an inpatient setting (p < 0.001). Fatigue caused the most distress at the start of an Unstable phase (community: mean = 5.0; sd 2.4; inpatient: mean = 4.2; sd 2.8). Patients in an inpatient setting reported marginal but statistically significant reductions in symptom distress in later Unstable phases relative to the first Unstable phase within an episode of care.This study provided evidence that the start of the Unstable phase is associated with higher levels of patient symptom distress, and that a patient’s symptom experience is contingent upon the setting where care is received. This information may serve to enhance services in their routine patient care, service delivery and planning. With improved patient and service outcomes, the financial and resource burden on the Australia health care system may be reduced.