THE PATIENT-CARE TRAVELING RECORD(C) IN PALLIATIVE CARE - EFFECTIVENESS AND EFFICIENCY

The Patient Care Travelling Record(C) (PCTR) is a passport-like health -care summary that, in previous research by the authors, has been foun d to be a feasible and acceptable tool to convey important clinical in formation about the palliative care patient. This randomized controlle d trial was conducted to determine the effectiveness and efficiency of this Record in improving patient mood, decreasing uncertainty, improv ing satisfaction with health care, reducing use of health-care service s, and maximizing pain control. Eligible patients were randomized to r eceive or not receive the PCTR (completed by nurse or physician and re viewed jointly with the patient). At baseline entry into the study and then at 1 and 2 months, patients completed measures on level of certa inty, mood states, satisfaction with care, levels of pain, and health- care services utilization. During the 2-year study period only 20 % (N = 61) of the patients enrolled in a palliative care program in Southe rn Ontario were eligible for the trial. Of these patients, 18 died, 15 declined to participate, and 7 were emotionally unable to complete th e questionnaires, Thus 21 patients completed the trial. With the excep tion of those age 65 years and over, the patients using the Record rep orted decreased levels of uncertainty on follow-up. There was no addit ional use of health-care services, no differences in mood states, pain relief; or satisfaction with health care. It is significant that 80 % of palliative patients were not eligible because their physical and p sychological status rendered them insufficiently stable to participate in a research study. Because of their vulnerable status, these patien ts may be ideal for the utilization of the Record in clinical care. Al though research in this palliative care population is challenging due to difficulties with recruitment and high dropout rates due to death, the PCTR, which was previously shown to be acceptable and feasible, ha s now been shown to be effective in reducing patient uncertainty, spec ifically for adults under 65 years. Indications for future research ar e described. (C) U.S. Cancer Pain Relief Committee, 1998.