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Improving Palliative Care Access Through Technology (ImPAcTT)

7 juli 2021 uppdaterad av: Caroline Stephens, University of Utah

Improving Palliative Care Access Through Technology (ImPAcTT): A Multi- Component Pilot Study

This project will focus on developing, optimizing and pilot-testing a multi-component Improving Access Through Technology (ImPAcTT) intervention that leverages existing telehealth technologies to provide staff education; family outreach, engagement and support; care coordination; and resident symptom management and facilitation of goals-of-care discussion.

Studieöversikt

Status

Upphängd

Betingelser

Intervention / Behandling

Detaljerad beskrivning

Almost 1.8 million older Americans live in nursing homes (NH), with estimates that this number will grow to more than 3 million by 2050. NHs are increasingly becoming the place of care and site of death for frail older adults dying from multiple chronic illnesses. Unfortunately, most residents die without the benefit of palliative care (PC) or with palliation delayed until the last days of life.

Unfortunately, hospice services are often the only formal end of life care service available in NHs, and access to hospice enrollment is complicated by financial implications for both NHs and residents.

Telehealth, or remote monitoring of patients through information and communication technologies, is an effective mechanism for addressing the increased demand on health services and has much to offer to people living with and dying from advanced illness. Moreover, numerous studies have demonstrated positive benefits of using telehealth in the NH to improve access to consultants (e.g., neurology, dermatology, psychiatry).

Little is known, however, about the effect of using Telehealth on improving access to PC specialists in the NH setting.

The proposed ImPAcTT intervention employs a secure communications platform that permits multi-person live video, audio, and text message consultations; real-time document sharing and documentation for advanced care planning discussions; and remote virtual assessment capabilities.

The investigator will conduct a pilot implementation trial of ImPAcTT in 3 study nursing homes to evaluate our ability to safely recruit and retain study participants, collect appropriate and accurate data, and determine preliminary estimates of an effect size of the intervention.

Studietyp

Interventionell

Inskrivning (Förväntat)

81

Fas

  • Inte tillämpbar

Kontakter och platser

Det här avsnittet innehåller kontaktuppgifter för dem som genomför studien och information om var denna studie genomförs.

Studieorter

  • Förenta staterna
    • California
      • San Francisco, California, Förenta staterna, 94143
        • University of California San Francisco - UCSF
    • Utah
      • Salt Lake City, Utah, Förenta staterna, 84112
        • University of Utah

Deltagandekriterier

Forskare letar efter personer som passar en viss beskrivning, så kallade behörighetskriterier. Några exempel på dessa kriterier är en persons allmänna hälsotillstånd eller tidigare behandlingar.

Urvalskriterier

Åldrar som är berättigade till studier

18 år och äldre (Vuxen, Äldre vuxen)

Tar emot friska volontärer

Nej

Kön som är behöriga för studier

Allt

Beskrivning

Purposeful sampling will take place in an attempt to collect data from a range of ethnically and racially diverse participants.

INCLUSION CRITERIA:

Primary participant

  • Age >= 18 years
  • English language fluency
  • Palliative Care Consult Screening Tool (PCCS) scoring 9 or above
  • If participant does not demonstrate capacity to consent, he/she must be able to assent to study procedures, be told of plan to approach surrogate and have a legally authorized representative available to provide consent

Family/friend caregivers:

  • Closest relative/next of kin/friend who is involved in the care of his/her loved one before and during the study period
  • English fluency

EXCLUSION CRITERIA:

Primary participant:

  • Enrolled in hospice
  • Unable to assent to study procedures
  • Expresses resistance or dissent to participation or the use of surrogate consent

Family/friend caregiver:

  • Life expectancy < 1 year (e.g., metastatic cancer)
  • Evidence of cognitive impairment or inability to consent to study procedures

Studieplan

Det här avsnittet ger detaljer om studieplanen, inklusive hur studien är utformad och vad studien mäter.

Hur är studien utformad?

Designdetaljer

  • Primärt syfte: Stödjande vård
  • Tilldelning: Icke-randomiserad
  • Interventionsmodell: Parallellt uppdrag
  • Maskning: Ingen (Open Label)

Vapen och interventioner

Deltagargrupp / Arm
Intervention / Behandling
Experimentell: ImPAcTT intervention
Within 48-72 hours of enrollment in the study, the primary participant and family will receive an ImPAcTT Telehealth visit with the PC provider. The provider will conduct a comprehensive PC assessment aligned with the National Consensus Project for Quality Palliative Care guidelines. Visits, which may include remote physical assessment using a digital stethoscope, dermatoscope, etc., will be documented and transmitted to the NH. Advanced Care Planning (ACP) and goals of care discussions will be facilitated by the ability to virtually share and edit documents, such as the Physician Orders for Life Sustaining Treatment (POLST), in real time with primary participants and/or family. The PC provider will conduct follow-up visits 1 week following the initial visit, then on a case-by-case basis.
Övrig: Telehealth visit
ImPACTT Telehealth visit with the PC provider
Inget ingripande: Usual care
Participants will receive the standard of care established at the NH.

Vad mäter studien?

Primära resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
Change in Symptom distress (composite measure)
Tidsram: Baseline and Last visit -12 weeks

Symptom distress as measured by the Edmonton Symptom Assessment Scale - ESAS

  • ESAS physical score (total of physical 6 symptoms, score range 0-60)
  • ESAS emotional score (total of 2 emotional symptoms, score range 0-60)
  • ESAS total symptom distress score (physical score + emotional score + well being)

For all symptom distress scores:

High score means: worst outcome Low score means: better outcome
Baseline and Last visit -12 weeks
Change in Symptom impact
Tidsram: Baseline and Last visit -12 weeks

Symptom impact as measured by the "Quality of Life at the End of Life" - QUAL-E

Symptom impact subscale:

Minimum value: 3 Maximum value: 15

High score means: worst outcome Low score means: better outcome
Baseline and Last visit -12 weeks

Sekundära resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
Change in number of completed POLST forms
Tidsram: Baseline and Last visit -12 weeks
Number of Physician's Orders for Life-Sustaining Treatment - POLST forms completed
Baseline and Last visit -12 weeks
Type of changes in POLST forms
Tidsram: Baseline and Last visit -12 weeks
Type of changes in Physician's Orders for Life-Sustaining Treatment -POLST forms
Baseline and Last visit -12 weeks
Number of In-hospital death
Tidsram: Baseline and Last visit -12 weeks
Number of In-hospital death
Baseline and Last visit -12 weeks
Change in Family Satisfaction
Tidsram: Baseline and Last visit -12 weeks

Family Satisfaction as measured by the "Quality of Life at the End of Life - Family" - QUAL-E Fam

Subscale: Relationship with Healthcare Provider [Questions #5-8 with 5 item Likert scales, average of 4 scores] Minimum value: 1 Maximum value: 5

High score means: worst outcome Low score means: better outcome
Baseline and Last visit -12 weeks
Number of residents transitioned to hospice
Tidsram: Last visit - week 12
Number of residents transitioned to hospice
Last visit - week 12
Change in acute care utilization (composite measure)
Tidsram: Baseline and Last visit -12 weeks
Number of ED Visits and number of Hospitalizations
Baseline and Last visit -12 weeks
Change in Functional Status
Tidsram: Baseline and Last visit -12 weeks

Functional Status as measured by the PalliativePerformance Scale (PPSv2)

Minimum value: 0% Maximum value: 100%

High score means: better outcome Low score means: worst outcome
Baseline and Last visit -12 weeks
Change in Depression Status
Tidsram: Baseline and Last visit -12 weeks

Depression as measured by the Patient Health Questionnaire-9 (PHQ-9)

Subscales:

- Question 1: Minimum value: 0 Maximum value: 27

High score means: worst outcome Low score means: better outcome

- Question 2: Minimum value: 1 Maximum value: 4

High score means: worst outcome Low score means: better outcome
Baseline and Last visit -12 weeks
Change in Cognitive Status
Tidsram: Baseline and Last visit -12 weeks

Cognition as measured by the Montreal - Cognitive Assessment (MoCA)

Minimum value: 0 Maximum value: 30

High score means: better outcome Low score means: worst outcome
Baseline and Last visit -12 weeks
Change in Mortality
Tidsram: Baseline and Last visit -12 weeks

Risk for dying within one year as measured by the Flacker Mortality Score

Minimum value: 0 Maximum value: 15.21

High score means: worst outcome Low score means: better outcome
Baseline and Last visit -12 weeks

Samarbetspartners och utredare

Det är här du hittar personer och organisationer som är involverade i denna studie.

Sponsor

University of Utah

Samarbetspartners

National Institute on Aging (NIA)

Utredare

  • Huvudutredare: Caroline E Stephens, PhD, RN, University of Utah

Publikationer och användbara länkar

Den som ansvarar för att lägga in information om studien tillhandahåller frivilligt dessa publikationer. Dessa kan handla om allt som har med studien att göra.

Allmänna publikationer

Användbara länkar

Studieavstämningsdatum

Dessa datum spårar framstegen för inlämningar av studieposter och sammanfattande resultat till ClinicalTrials.gov. Studieposter och rapporterade resultat granskas av National Library of Medicine (NLM) för att säkerställa att de uppfyller specifika kvalitetskontrollstandarder innan de publiceras på den offentliga webbplatsen.

Studera stora datum

Studiestart (Faktisk)

19 februari 2018

Primärt slutförande (Förväntat)

30 juni 2022

Avslutad studie (Förväntat)

30 juni 2022

Studieregistreringsdatum

Först inskickad

4 maj 2021

Först inskickad som uppfyllde QC-kriterierna

7 juli 2021

Första postat (Faktisk)

20 juli 2021

Uppdateringar av studier

Senaste uppdatering publicerad (Faktisk)

20 juli 2021

Senaste inskickade uppdateringen som uppfyllde QC-kriterierna

7 juli 2021

Senast verifierad

1 juli 2021

Mer information

Termer relaterade till denna studie

Nyckelord

Andra studie-ID-nummer

  • IRB_00129094
  • 5K76AG054862-05 (U.S.S. NIH-anslag/kontrakt)

Plan för individuella deltagardata (IPD)

Planerar du att dela individuella deltagardata (IPD)?

JA

IPD-planbeskrivning

Data (complete dataset with full documentation including metadata, protocols, etc) will be made available by the online publication date unless the NIH policy specifies an earlier date. The PI will work the primary mentor to ensure that the study data are submitted to the PCRC De-identified Data Repository. (https://palliativecareresearch.org/corescenters/data-informatics-statistics-core-disc/pcrc-de-identified-data-repository-didr).

This would allow for secondary data analyses of the data to be conducted and support those who need access to these datasets for preliminary data and/or grant proposal preparation. Human subject data will be shared with other investigators within the limits of HIPAA and other patient confidentiality requirements, including the removal of all participant identifiers from all source documents and the use of unique participant identification numbers, and in accordance with PCRC protocols.

Tidsram för IPD-delning

Data will be made available by the online publication date unless the NIH policy specifies an earlier date.

Kriterier för IPD Sharing Access

This study has specific data and resource sharing plans to make data available both to the community of scientists interested in palliative care and nursing home research to avoid unintentional duplication of research. Moreover, the investigator would welcome collaboration with others who could make use of the Telehealth visit protocols developed in this ImPAcTT project.

IPD-delning som stöder informationstyp

  • STUDY_PROTOCOL
  • SAV
  • ICF
  • ANALYTIC_CODE
  • CSR

Läkemedels- och apparatinformation, studiedokument

Studerar en amerikansk FDA-reglerad läkemedelsprodukt

Nej

Studerar en amerikansk FDA-reglerad produktprodukt

Nej

Denna information hämtades direkt från webbplatsen clinicaltrials.gov utan några ändringar. Om du har några önskemål om att ändra, ta bort eller uppdatera dina studieuppgifter, vänligen kontakta register@clinicaltrials.gov. Så snart en ändring har implementerats på clinicaltrials.gov, kommer denna att uppdateras automatiskt även på vår webbplats .

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