- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04414787
A Needs-focused Palliative Care Intervention for Older Adults in ICUs (PCplanner)
Operationalizing PCplanner, a Needs-focused Palliative Care for Older Adults in Intensive Care Units: a Randomized Clinical Trial
The quality of intensive care unit (ICU)-based palliative care is highly variable, particularly for the 2 million older adults admitted annually to ICUs. To address these care delivery barriers among older ICU patients, a mobile app platform called PCplanner (Palliative Care planner) was developed. PCplanner automates the identification of high-risk patients (e.g., dementia, declining health status, poor functioning) by directly capturing data from electronic health record (EHR) systems, cultivates family engagement with supportive information and a digital system for self-report of actual needs, and facilitates the delivery of care to those with a high burden of need by coordinating collaboration between ICU teams and palliative care specialists.
150 patients, 150 family caregivers, and 75 physicians from academic and community settings will be enrolled in a RCT designed to test the efficacy of PCplanner-augmented collaborative palliative care vs usual care. Family caregiver and clinician experiences will be explored using mixed methods to understand intervention mechanisms as well as implementation barriers within diverse case contexts. The key hypothesis is that compared to usual care, PCplanner will reduce family caregivers' unmet needs and psychological distress, increase the frequency of goal concordant treatment among older adult patients, and reduce hospital length of stay.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
The quality of intensive care unit (ICU)-based palliative care is highly variable, particularly for the 2 million older adults admitted annually to ICUs. However, improving care quality on a broad scale with the efficient delivery of patient-centered, need-targeted palliative care is challenging because of logistical and technological barriers. To address these care delivery barriers among older ICU patients, a mobile app platform called PCplanner (Palliative Care planner) was developed. PCplanner automates the identification of high-risk patients (e.g., dementia, declining health status, poor functioning) by directly capturing data from electronic health record (EHR) systems, cultivates family engagement with supportive information and a digital system for self-report of actual needs, and facilitates the delivery of care to those with a high burden of need by coordinating collaboration between ICU teams and palliative care specialists. In pilot comparison to a standard palliative care control, the intervention reduced unmet needs, psychological distress, and length of stay and increased goal concordant care, communication, and hospice utilization.
While these data are compelling, an efficacy evaluation of PCplanner is needed. Therefore, 150 patients, 150 family caregivers, and 75 physicians will be enrolled from academic and community settings in a project with 2 key aims: (1) Test the efficacy of PCplanner-augmented collaborative palliative care vs usual care in a randomized clinical trial (RCT) with 3-month follow up, and (2) Explore family caregiver and clinician experiences using mixed methods to understand intervention mechanisms as well as implementation barriers within diverse case contexts. The key hypothesis is that compared to usual care, PCplanner will reduce family caregivers' unmet needs and psychological distress, increase the frequency of goal concordant treatment among older adult patients, and reduce hospital length of stay.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Allie Frear
- Phone Number: 919-684-8914
- Email: allie.frear@duke.edu
Study Contact Backup
- Name: Christopher Cox, MD
- Phone Number: 919-681-7232
- Email: Christopher.cox@duke.edu
Study Locations
-
-
North Carolina
-
Durham, North Carolina, United States, 27710
- Duke University Medical Center
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
PATIENTS
Inclusion Criteria:
- ≥50 years of age
- Receive care in a study ICU for ≥24 hours
- Meets ≥1 of 9 high risk phenotypes a. Dementia (e.g., Alzheimer's, multi-infarct, other dementia etiology) b. Declining health status defined by EITHER: i. ≥2 hospital admissions in 3 months preceding current admission OR ii. >1 ICU admission in 3 months preceding current admission c. Poor functional status defined by EITHER: i. admit from Skilled Nursing Facility (SNF) or Long-Term Acute Care (LTAC) facility OR ii. ≥3 activities of daily living (ADL) limitations at admission d. Severe acute illness defined by EITHER: i. cardiac arrest OR ii. multisystem organ failure (≥3 of: lung, kidney, hematological, brain, cardiac, liver) that has worsened over 48 hours (i.e., Sequential Organ Failure Assessment [SOFA] score increase) e. Severe acute stroke (e.g., acute intracranial hemorrhage, ischemic stroke, or traumatic brain injury) f. Acute respiratory failure (ventilation or high oxygen support for ≥24 hours) g. Acute renal failure (new hemodialysis or continuous venovenous hemodiafiltration for ≥1 hour) h. Advanced cancer (Advanced / metastatic cancer diagnosis) i. Shock (use of vasopressor or inotrope for ≥4 hours)
Exclusion Criteria (pre-consent):
- Palliative care consultation performed during the hospitalization before eligibility determination
- Current admission to ICU at the index hospital ≥8 days
- Imprisoned
- No known family or surrogate decision maker
- Death expected within 24 hours
Exclusion Criteria (post-consent):
- Patient dies before T2
FAMILY MEMBER
Inclusion Criteria:
- ≥18 years of age
- Self-described as the individual (related or unrelated) who provides the most support and with whom the patient has a significant relationship (per definition of 'family' described in the Society of Critical Care Medicine 2016 Guidelines for Family-Centered Care in the Neonatal, Pediatric, and Adult ICU)
Exclusion Criteria (pre-consent):
- Lack a knowledge of English such that the potential participant is not confident that they could complete study tasks (app viewing, surveys)
- Imprisoned
- Unable to complete surveys for any reason
Exclusion Criteria (post-consent):
- Low need burden (NEST score <10) at baseline
ICU PHYSICIANS
Inclusion Criteria:
- ≥18 years of age
- Attending or fellow physician in a study ICU
Exclusion Criteria:
- None
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Supportive Care
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Intervention
PCplanner intervention during hospitalization
|
PCplanner-augmented care.
The PCplanner mobile app will allow patients / family members to report their needs in a platform viewable by ICU physicians.
Should the needs not improve over time, the palliative care team will be activated to contribute to care.
|
No Intervention: Usual care control
Usual care
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Needs; Existential concerns; Symptoms; and Therapeutic interaction (NEST) scale total score
Time Frame: Time 1 (baseline), Time 2 (target ~3 days post-randomization), and Time 3 (target ~1 week post-randomization)
|
A palliative care needs instrument.
Scores range from 0 (no needs) to 130 (higher needs)
|
Time 1 (baseline), Time 2 (target ~3 days post-randomization), and Time 3 (target ~1 week post-randomization)
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Post-Traumatic Stress Symptom (PTSS) inventory
Time Frame: Time 1 (baseline) and Time 4 (3 months post-randomization)
|
A post-traumatic stress disorder symptom instrument.
Scores range from 10 (low PTSD symptoms) to 70 (higher PTSD symptoms)
|
Time 1 (baseline) and Time 4 (3 months post-randomization)
|
Post-randomization hospital length of stay
Time Frame: Across the entire hospitalization after randomization (approximately 2 weeks)
|
A measure of hospital days after randomization
|
Across the entire hospitalization after randomization (approximately 2 weeks)
|
Post-randomization intensive care unit length of stay
Time Frame: Across the entire hospitalization after randomization (approximately 2 weeks)
|
A measure of intensive care unit days after randomization
|
Across the entire hospitalization after randomization (approximately 2 weeks)
|
Patient Health Questionnaire 9-Item scale (PHQ-9)
Time Frame: Time 1 (baseline), Time 3 (target ~1 week post-randomization), and Time 4 (3 months post-randomization)
|
A depression symptoms instrument.
Scores range from 0 (no depression symptoms) to 27 (higher depression symptoms)
|
Time 1 (baseline), Time 3 (target ~1 week post-randomization), and Time 4 (3 months post-randomization)
|
Generalized Anxiety Disorder 7-Item scale (GAD-7)
Time Frame: Time 1 (baseline), Time 3 (target ~1 week post-randomization), and Time 4 (3 months post-randomization)
|
An anxiety symptoms instrument.
Scores range from 0 (no anxiety symptoms) to 21 (higher anxiety symptoms)
|
Time 1 (baseline), Time 3 (target ~1 week post-randomization), and Time 4 (3 months post-randomization)
|
Goal concordant care
Time Frame: Time 1 (baseline), Time 2 (target ~3 days post-randomization), and Time 3 (target ~1 week post-randomization)
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A measure of hospital days after randomization
|
Time 1 (baseline), Time 2 (target ~3 days post-randomization), and Time 3 (target ~1 week post-randomization)
|
Patient-Perceived Patient-Centeredness (PPPC) scale
Time Frame: Time 3 (target ~1 week post-randomization)
|
A measure of patient-centeredness with scores that range from 12 (higher patient-centeredness) to 48 (lower patient-centeredness)
|
Time 3 (target ~1 week post-randomization)
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Christopher Cox, MD, Duke University
Publications and helpful links
General Publications
- Cox CE, Jones DM, Reagan W, Key MD, Chow V, McFarlin J, Casarett D, Creutzfeldt CJ, Docherty SL. Palliative Care Planner: A Pilot Study to Evaluate Acceptability and Usability of an Electronic Health Records System-integrated, Needs-targeted App Platform. Ann Am Thorac Soc. 2018 Jan;15(1):59-68. doi: 10.1513/AnnalsATS.201706-500OC.
- Cox CE, Olsen MK, Casarett D, Haines K, Al-Hegelan M, Bartz RR, Katz JN, Naglee C, Ashana D, Gilstrap D, Gu J, Parish A, Frear A, Krishnamaneni D, Corcoran A, Docherty SL. Operationalizing needs-focused palliative care for older adults in intensive care units: Design of and rationale for the PCplanner randomized clinical trial. Contemp Clin Trials. 2020 Nov;98:106163. doi: 10.1016/j.cct.2020.106163. Epub 2020 Sep 29.
Helpful Links
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- Pro00101745
- R01AG058915 (U.S. NIH Grant/Contract)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- SAP
- ICF
- ANALYTIC_CODE
- CSR
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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