Abstract Details

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

Topic Pain

Presentation(s) S52 - From Bench to Bedside with Novel Treatments for Pain (4:18 PM-4:30 PM)

Poster/Presentation
Number 005

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.

Objective To pilot the use of a trigger-based method for specialty Palliative Care referral in individuals with Parkinson disease (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.

Authors/Disclosures
Christopher Tarolli, MD (University of Rochester) PRESENTER	Dr. Tarolli has received personal compensation for serving as an employee of University of Rochester. The institution of Dr. Tarolli has received research support from National Institutes of Health. The institution of Dr. Tarolli has received research support from Biogen. The institution of Dr. Tarolli has received research support from Neuron23. Dr. Tarolli has received personal compensation in the range of $500-$4,999 for serving as a Speaker with Davis Phinney Foundation. Dr. Tarolli has received personal compensation in the range of $500-$4,999 for serving as a Speaker, Committee Member with ��ɫ��. Dr. Tarolli has a non-compensated relationship as a Committee Member with ��ɫ�� that is relevant to AAN interests or activities.
Grace A. Zimmerman, MPH (University of Rochester)	The institution of Ms. Zimmerman has received research support from National Institutes of Health. The institution of Ms. Zimmerman has received research support from Batten Disease Support and Research Association. The institution of Ms. Zimmerman has received research support from Greater Rochester Health Foundation.
E. Ray Dorsey, MD, MBA (University of Rochester)	Dr. Dorsey has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Seelos Therapeutics. Dr. Dorsey has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eden McCallum, LLP. Dr. Dorsey has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Genentech/Roche. Dr. Dorsey has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biohaven Pharmaceuticals. Dr. Dorsey has received personal compensation in the range of $500-$4,999 for serving as a Consultant for WebMD. Dr. Dorsey has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for BioSensics. Dr. Dorsey has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Mediflix. Dr. Dorsey has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cerevance. Dr. Dorsey has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Kairos Cinema, LLC. Dr. Dorsey has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Mitsubishi Tanabe Pharma America Inc.. Dr. Dorsey has received personal compensation in the range of $500-$4,999 for serving as a Consultant for HanAll. Dr. Dorsey has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Dorsey has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi. Dr. Dorsey has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Advarra. Dr. Dorsey has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medrhythms. Dr. Dorsey has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for ANA. Dr. Dorsey has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for HMP ��ɫ��, LLP. Dr. Dorsey has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for ADIVO Associates France. Dr. Dorsey has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for University of Toronto. Dr. Dorsey has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Philadelphia Neurological Society. Dr. Dorsey has stock in Included Health. Dr. Dorsey has stock in Mediflix. Dr. Dorsey has stock in SemCap. Dr. Dorsey has stock in Synapticure. The institution of Dr. Dorsey has received research support from NIH/NINDS. The institution of Dr. Dorsey has received research support from Burroughs Wellcome . The institution of Dr. Dorsey has received research support from Michael J. Fox Foundation - Fox Insight. The institution of Dr. Dorsey has received research support from Michael J. Fox Foundation - Emerald. The institution of Dr. Dorsey has received research support from B. Thomas Golisano Foundation. The institution of Dr. Dorsey has received research support from Emerald Innovations, Inc.. The institution of Dr. Dorsey has received research support from Photopharmics Inc.. The institution of Dr. Dorsey has received research support from Averitas Pharma Inc.. The institution of Dr. Dorsey has received research support from DOD/Army Medical Research Acquisition Activity. The institution of Dr. Dorsey has received research support from NIH/NINDS.
	No disclosure on file
Benzi Kluger, MD, FAAN (University of Rochester)	Dr. Kluger has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for International Neuropalliative Care Society. The institution of Dr. Kluger has received research support from NIH. The institution of Dr. Kluger has received research support from PCORI.
Robert G. Holloway, MD, MPH, FAAN (University of Rochester Medical Center)	Dr. Holloway has nothing to disclose.

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