Evaluation of a Comprehensive, Adaptable, Life- Affirming, Longitudinal (CALL) palliative care project.

Background: Many persons with life-threatening illnesses require services before they begin receiving hospice or hospital-based palliative care. Although health care professionals focus on diagnosis, treatment, and comfort care, patients and families view the illness as it impacts their whole life.

Objective: Evaluating a Comprehensive, Adaptable, Life-Affirming, Longitudinal (CALL) intervention to patients with life-threatening cancer, cardiac illness, respiratory conditions or dementia. The CALL Care interventions are consistent with the 2004 Clinical Practice Guidelines for Quality Palliative Care.

Design: Prospective observational study.

Setting And Subjects: Eleven sites (1 primary care, 8 acute care, and 2 long term care) located around the United States. Two hundred ninety-five patients and families enrolled in the study; many were enrolled for over 12 months.

Measurements: Patient self-reported Modified City of Hope Questionnaire addressing physical, psychosocial, emotional, and spiritual status and health care experiences; completed at enrollment and every three months. Family members completed Modified City of Hope Bereaved Family Questionnaire, with contents similar to the patient questionnaire. Sites compiled health care and community services utilization data regularly.

Results: Participants reported improved pain and symptom management. Fewer than one third were hospitalized (29%), and 7% had a critical care admission while enrolled. In addition, participants had high use of hospice (48% of those who died), and were likely to die at home (38% of those who died).

Conclusions: CALL Care is an effective interdisciplinary intervention approach to individualize care for people living with life-threatening illness.