LiverPAL: uno studio randomizzato di cure palliative ospedaliere per pazienti con malattia epatica avanzata (LiverPAL)
The goal of this clinical trial is to evaluate whether early integration of palliative care in the care of hospitalized patients with advanced liver disease (AdvLD) can improve patients' quality of life, physical symptoms, mood, and serious illness communication. Palliative care is a medical specialty focused on lessening (or "palliating") symptoms and assisting in coping with serious illness.
Panoramica dello studio
Stato
Condizioni
Intervento / Trattamento
Descrizione dettagliata
The main purpose of this study is to compare two types of care - usual hepatology care and usual hepatology care with early involvement of palliative care clinicians to see which is better for improving the experience of hospitalized patients with advanced liver disease (AdvLD).
The investigators aim to find out whether introducing hospitalized patients with AdvLD to the palliative care team that specializes in symptom management can improve the quality of life and physical and psychological symptoms that patients and families experience during their hospitalizations as well as enhance the quality of patients' end of life care.
Tipo di studio
Iscrizione (Effettivo)
Fase
- Non applicabile
Contatti e Sedi
Luoghi di studio
-
-
Massachusetts
-
Boston, Massachusetts, Stati Uniti, 02114
- Massachusetts General Hospital
-
-
Criteri di partecipazione
Criteri di ammissibilità
Età idonea allo studio
Accetta volontari sani
Sessi ammissibili allo studio
Descrizione
Patient Inclusion Criteria:
-
Hospitalized patient with a diagnosis of advanced liver disease, defined as cirrhosis with one of the following (new or ongoing) within the prior six months from date of consent:
- Ascites (requiring diuretics or serial large volume paracenteses)
- Spontaneous bacterial peritonitis
- Hepatic hydrothorax (requiring diuretics)
- Variceal bleed (with one or more occurrences)
- Overt hepatic encephalopathy (requiring medications)
-
Ability to comprehend English
Patient Exclusion Criteria:
- Prior history of liver transplantation
- Have uncontrolled hepatic encephalopathy, cognitive impairment, psychiatric disorder or other comorbid condition which the primary medical, hepatology, and/or transplant surgery teams believes prohibits the ability to provide informed consent
- Current or recent (within 5 years of receiving curative cancer treatment) history of extrahepatic malignancy (excluding non-melanoma skin cancer)
- Presence of hepatocellular carcinoma beyond Milan criteria
- Are already receiving hospice care
- Receive a score of <10 on the Simplified Animal Naming Test
Caregiver Inclusion Criteria
- Adult caregiver (≥ 18 years of age)
- A relative or friend identified by the patient upon whom the patient relies for help and who likely is to be present in-person during hospitalizations or clinic appointments, or willing to participate by phone
- Ability to comprehend English and can complete questionnaires
Caregiver Exclusion Criteria
1. Inability to comprehend English
Piano di studio
Come è strutturato lo studio?
Dettagli di progettazione
- Scopo principale: Terapia di supporto
- Assegnazione: Randomizzato
- Modello interventistico: Assegnazione di gruppo singolo
- Mascheramento: Nessuno (etichetta aperta)
Armi e interventi
Gruppo di partecipanti / Arm |
Intervento / Trattamento |
|---|---|
|
Nessun intervento: Usual Hepatology Care
Usual hepatology care |
|
|
Sperimentale: Usual Hepatology Care with Early Palliative Care
Usual hepatology care with early palliative care |
The intervention include integrating early palliative care with usual hepatology care to evaluate and treat patients' symptoms, enhance their illness and prognostic understanding, support their coping, and coordinate their serious illness, transitional, and end-of-life care. |
Cosa sta misurando lo studio?
Misure di risultato primarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
|
Patient Quality of Life (Functional Assessment of Chronic Illness Therapy - Palliative Care, FACIT-Pal) up t0 4 weeks
Lasso di tempo: Up to 4 weeks
|
Compare patient quality of life (FACIT-Pal) scores up to 4 weeks adjusting for baseline quality of life scores between the study arms. Score range 0-184 with higher scores indicating better quality of life. |
Up to 4 weeks
|
Misure di risultato secondarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
|
Patient FACIT-Pal Score longitudinally between study arms
Lasso di tempo: Up to 6 months
|
Compare patient quality of life (FACIT-Pal) scores longitudinally between the study arms. Score range 0-184 with higher scores indicating better quality of life. |
Up to 6 months
|
|
Patient Symptom Burden (revised Edmonton Symptom Assessment Scale, ESAS-r)
Lasso di tempo: Up to 6 months
|
Compare patient symptom burden scores (ESAS-r) between the study arms. Score range 0-100 with higher scores indicating higher symptom burden. |
Up to 6 months
|
|
Patient Depression Symptoms (Hospital Anxiety and Depression Scale, HADS-D)
Lasso di tempo: Up to 6 months
|
Compare patient depression symptoms (HADS-D) between the study arms. Score range 0-21 with higher scores indicating higher depression symptoms. |
Up to 6 months
|
|
Patient Anxiety Symptoms (Hospital Anxiety and Depression Scale, HADS-A)
Lasso di tempo: Up to 6 months
|
Compare patient anxiety symptoms (HADS-A) between study arms. Score range 0-21 with higher scores indicating higher anxiety symptoms. |
Up to 6 months
|
|
Patient End-of-Life (EOL) Care Communication with Clinicians
Lasso di tempo: Final assessment prior to patient death or at 6 months
|
"Has [participant] talked with [participant's] doctor about the kind of medical care [participant] would want if [participant] were very sick or near the end of life?" |
Final assessment prior to patient death or at 6 months
|
|
Documentation of Patient End-of-Life (EOL) Care Preferences
Lasso di tempo: After patient death, up to 60 months
|
Compare documentation of EOL care preferences in the electronic health record between study arms since baseline. |
After patient death, up to 60 months
|
Collaboratori e investigatori
Sponsor
Collaboratori
Investigatori
- Investigatore principale: Nneka Ufere, MD MSCE, Massachusetts General Hospital
Studiare le date dei record
Studia le date principali
Inizio studio (Effettivo)
Completamento primario (Stimato)
Completamento dello studio (Stimato)
Date di iscrizione allo studio
Primo inviato
Primo inviato che soddisfa i criteri di controllo qualità
Primo Inserito (Effettivo)
Aggiornamenti dei record di studio
Ultimo aggiornamento pubblicato (Effettivo)
Ultimo aggiornamento inviato che soddisfa i criteri QC
Ultimo verificato
Maggiori informazioni
Termini relativi a questo studio
Termini MeSH pertinenti aggiuntivi
Altri numeri di identificazione dello studio
- 2023P001894
- 80736 (Altro numero di sovvenzione/finanziamento: Robert Wood Johnson Foundation)
- 242379 (Altro numero di sovvenzione/finanziamento: Cambia Health Foundation)
- 243432 (Altro numero di sovvenzione/finanziamento: American Association for the Study of Liver Diseases)
- 236965 (Altro numero di sovvenzione/finanziamento: Massachusetts General Hospital Executive Committee on Researrch)
Informazioni su farmaci e dispositivi, documenti di studio
Studia un prodotto farmaceutico regolamentato dalla FDA degli Stati Uniti
Studia un dispositivo regolamentato dalla FDA degli Stati Uniti
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