- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02858778
Timing of Acute Palliative Care Consultation in Critically Ill Patients
August 3, 2016 updated by: Robert Zalenski, Wayne State University
A Randomized Allocation of Palliative Care Consultation in the Emergency Department Compared to Usual Practice
A prospective randomized controlled trial studying the ordering of palliative care consultations in the emergency department (Ig) versus later palliative care consultations in the hospital--ICU or hospital ward(Cg).
Patients will be randomly allocated to Ig or Cg with a 1:1 ratio.
Study Overview
Status
Unknown
Conditions
Intervention / Treatment
Study Type
Interventional
Enrollment (Anticipated)
120
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
-
-
Michigan
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Detroit, Michigan, United States, 48201
- Detroit Medical Center Detroit Receiving Hospital
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Detroit, Michigan, United States, 48235
- Detroit Medical Center Sinai Grace Hospital
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-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
65 years and older (OLDER_ADULT)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Greater than or equal to 65 years old
- Treated in a resuscitation room for unstable vital signs or respiratory compromise
- One or more of the following:
- Advanced or metastatic solid organ cancer
- End stage organ failure of the heart, lung/COPD, kidney on dialysis, hepatic encephalopathy
- Suspected sepsis
- Advanced dementia, end-state multiple sclerosis or Parkinson's disease
- Status post cardiac arrest with coma (Glascow coma score <7)
- Patient is from a skilled nursing facility
Exclusion Criteria:
- Lack decision capacity and have no relative available during ED stay to consent to the study (legally authorized representative-LAR)
- Enrolled in hospice care prior to randomization
- A copy of a completed advance directive which names a designated proxy provided physically to the medical team prior to randomization
- Wearing a DNR bracelet
- Have been previously enrolled in this study
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: SUPPORTIVE_CARE
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: DOUBLE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
EXPERIMENTAL: Interventional group (Ig)
The interventional group (Ig) will have an early palliative care consultation ordered during their stay in the emergency department.
|
|
NO_INTERVENTION: Control group (Cg)
The control group will be treated as standard of care.
Palliative care consultations may or may not be ordered at the attending physician's discretion.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
The difference in the percentage of patients with a completed advance directive (AD) in Ig vs.Cg
Time Frame: 1 year
|
1 year
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
The proportion of billed CMS ACP-CPT codes in Ig vs. Cg
Time Frame: 30 days from enrolled patients' hospital discharge
|
The proportion of patients who received an ACP CMS billing codes (which took effect in January 2016), in Ig vs. Cg will be evaluated using one or both of the new CPT codes for Advance care planning (ACP) services…including the explanation and discussion of advance directives such as standard forms (with the completion of such forms, when performed) by the physician or other qualified health profession; first 30 (15-45)minutes, face to face with the patients, family member(s) and/or surrogate Code 99497; and each additional 30 (46-75 minutes)-Code 99498 (Federal Register, 2015).
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30 days from enrolled patients' hospital discharge
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Matches of care received to patient-specific preferences in Ig vs. Cg
Time Frame: 1 year
|
The investigators will align treatment preferences with medical orders, replicated as reported in the study by Mack et al.
Proportions of patients coded as having a match will be compared across the treatment and control groups.
For everyone who gets ACP during the study, patients or their surrogates will be asked by a member of the care team-either palliative care if they are consulted, or the hospital based care team if they are not: "If you could choose, would you prefer (a) treatment that focuses on attempting to extend your time as much as possible, even if doing so means more pain and discomfort, or (b) a plan of care that focuses on relieving pain and discomfort and improving quality of life, even though that may mean not living as long.
|
1 year
|
Patient/family satisfaction with care in Ig vs. Cg
Time Frame: Baseline
|
This outcome will be measured on a continuous scale.
The net-promoter score will be measured at baseline (at randomization) and at hospital discharge for a change in value.
It is measured on a scale of 1-10.
Whoever signs the consent (patient of LAR) will be asked the net promoter score, and that will be reassessed by them at discharge, unless the patient has died-and the variable will then be recorded as missing.
The PSQ will be administered by research assistants at the time of the patient's discharge.
If the patient is incapacitated, then it will be asked of the patient's closest family caregiver.
So PSQ is only at discharge of patient or available, most involved, family caregiver.
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Baseline
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Amount of hospice referrals in Ig vs. Cg
Time Frame: 1 year
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1 year
|
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Hospital total direct costs for the index visit in Ig vs. Cg
Time Frame: 1 year
|
1 year
|
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Hospital and ICU length of stay in Ig vs. Cg
Time Frame: 1 year
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1 year
|
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Average days in hospice in Ig vs. Cg
Time Frame: 1 year
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1 year
|
|
Hospital margin contribution for the index visit in Ig vs. Cg
Time Frame: 1 year
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1 year
|
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Time to consultation in Ig vs. Cg groups
Time Frame: 1 year
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1 year
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Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Collaborators
Investigators
- Principal Investigator: Robert Zalenski, M.D., M.A., Wayne State University
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start
June 1, 2016
Primary Completion (ANTICIPATED)
January 1, 2017
Study Registration Dates
First Submitted
July 20, 2016
First Submitted That Met QC Criteria
August 3, 2016
First Posted (ESTIMATE)
August 8, 2016
Study Record Updates
Last Update Posted (ESTIMATE)
August 8, 2016
Last Update Submitted That Met QC Criteria
August 3, 2016
Last Verified
August 1, 2016
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Digestive System Diseases
- Liver Failure
- Hepatic Insufficiency
- Pathologic Processes
- Heart Diseases
- Cardiovascular Diseases
- Metabolic Diseases
- Central Nervous System Diseases
- Nervous System Diseases
- Respiratory Tract Diseases
- Immune System Diseases
- Demyelinating Autoimmune Diseases, CNS
- Autoimmune Diseases of the Nervous System
- Demyelinating Diseases
- Autoimmune Diseases
- Lung Diseases
- Urologic Diseases
- Liver Diseases
- Renal Insufficiency
- Parkinsonian Disorders
- Basal Ganglia Diseases
- Movement Disorders
- Synucleinopathies
- Neurodegenerative Diseases
- Shock
- Brain Diseases, Metabolic
- Heart Failure
- Multiple Sclerosis
- Kidney Diseases
- Renal Insufficiency, Chronic
- Lung Diseases, Obstructive
- Pulmonary Disease, Chronic Obstructive
- Parkinson Disease
- Hepatic Encephalopathy
- Brain Diseases
- Multiple Organ Failure
Other Study ID Numbers
- BCBSMF PSACO
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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