Palliative Care in the ICU

NCT03263143 | Completed

• 1 other identifier: 201707067
• Study Type: interventional
• Target: 242
• Locations: 1 country
• Sites: 1

Brief Summary

The study compares early palliative care consultation to standard of care in the medical intensive care unit (ICU). The study will assess if the intervention leads to an increased proportion of clearly delineated goals of care and examine if this intervention leads to decreased healthcare resource utilization such as length of stay, duration of intensive treatments including mechanical ventilation, and hospital re-admissions.

Conditions

Palliative Care

Outcome Measures

Primary Outcomes (1)

• Change in code status to do-not-resuscitate/do-not-intubate

  As determined by code status orders in the electronic medical record

  Through patient admission until discharge, charts reviewed an average of one month after discharge

Secondary Outcomes (13)

• Number of participants with Cardiopulmonary Resuscitation (CPR) performed

  Through study completion, an average of 6 months

• Mechanical Ventilation usage and duration

  After date of discharge, charts reviewed an average of one month after discharge

• Hospital Length of Stay

  After date of discharge, charts reviewed an average of one month after discharge

• ICU Length of Stay

  After date of discharge, charts reviewed an average of one month after discharge

• In-hospital mortality

  After date of discharge, charts reviewed an average of one month after discharge

Study Arms (2)

Standard of Care

NO INTERVENTION

Early Palliative Care Consultation

OTHER

Other: Palliative Care

Interventions

Palliative Care OTHER

Palliative Care Consultation within 24 to 48 hours after admission

Early Palliative Care Consultation

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Admitted to the ICU in the last 24 hours
• Admitted from Skilled nursing facility (SNF), long term acute care (LTAC)facility, long term ventilator care (vent LTC) unit, or home care with private duty nursing with activity of daily living (ADL) dependencies
• End-stage dementia, amyotrophic lateral sclerosis, Parkinson's, multiple sclerosis
• Advanced or Metastatic Cancer
• Cardiac or respiratory arrest with neurological compromise
• Multi- organ system failure (more than 2 organ failures)
• Known diagnosis of end stage organ disease including cirrhosis, end-stage renal disease, congestive heart failure New York Heart Association \>III, chronic obstructive pulmonary disease on home O2
• Shock requiring \> 6 hours of vasopressors or inotropes
• Acute Respiratory failure requiring intubation or BiPAP
• Admitted to ICU with hospital length of stay of more than 5 days or ICU readmission with the same diagnosis in 30 days.

You may not qualify if:

• All stem cell transplant patients, for solid organ transplant, if undergoing evaluation for solid organ transplant or within 1 year post-transplant.
• Patients who do not speak English if interpreter is unavailable
• Patients without capacity to participate in palliative care discussions without a surrogate available
• Patients or patient surrogate refusal of palliative care consultation
• Prior Palliative Care Consultation during the same hospitalization
• For purposes of primary outcome analysis, patients determined to already be DNR/DNI at time of ICU admission

Sponsors & Collaborators

• Washington University School of Medicine: lead

Study Sites (1)

Barnes Jewish Hospital

St Louis, Missouri, 63110, United States

Location

Related Publications (9)

• Adelson K, Paris J, Horton JR, Hernandez-Tellez L, Ricks D, Morrison RS, Smith CB. Standardized Criteria for Palliative Care Consultation on a Solid Tumor Oncology Service Reduces Downstream Health Care Use. J Oncol Pract. 2017 May;13(5):e431-e440. doi: 10.1200/JOP.2016.016808. Epub 2017 Mar 17.

  PMID: 28306372 BACKGROUND

• Aslakson R, Cheng J, Vollenweider D, Galusca D, Smith TJ, Pronovost PJ. Evidence-based palliative care in the intensive care unit: a systematic review of interventions. J Palliat Med. 2014 Feb;17(2):219-35. doi: 10.1089/jpm.2013.0409.

  PMID: 24517300 BACKGROUND

• Hsu-Kim C, Friedman T, Gracely E, Gasperino J. Integrating Palliative Care into Critical Care: A Quality Improvement Study. J Intensive Care Med. 2015 Sep;30(6):358-64. doi: 10.1177/0885066614523923. Epub 2014 Mar 5.

  PMID: 24603677 BACKGROUND

• Khandelwal N, Kross EK, Engelberg RA, Coe NB, Long AC, Curtis JR. Estimating the effect of palliative care interventions and advance care planning on ICU utilization: a systematic review. Crit Care Med. 2015 May;43(5):1102-11. doi: 10.1097/CCM.0000000000000852.

  PMID: 25574794 BACKGROUND

• Kyeremanteng K, Gagnon LP, Thavorn K, Heyland D, D'Egidio G. The Impact of Palliative Care Consultation in the ICU on Length of Stay: A Systematic Review and Cost Evaluation. J Intensive Care Med. 2018 Jun;33(6):346-353. doi: 10.1177/0885066616664329. Epub 2016 Aug 31.

  PMID: 27582396 BACKGROUND

• Penrod JD, Pronovost PJ, Livote EE, Puntillo KA, Walker AS, Wallenstein S, Mercado AF, Swoboda SM, Ilaoa D, Thompson DA, Nelson JE. Meeting standards of high-quality intensive care unit palliative care: clinical performance and predictors. Crit Care Med. 2012 Apr;40(4):1105-12. doi: 10.1097/CCM.0b013e3182374a50.

  PMID: 22202706 BACKGROUND

• Mun E, Ceria-Ulep C, Umbarger L, Nakatsuka C. Trend of Decreased Length of Stay in the Intensive Care Unit (ICU) and in the Hospital with Palliative Care Integration into the ICU. Perm J. 2016 Fall;20(4):16-036. doi: 10.7812/TPP/16-036. Epub 2016 Aug 31.

  PMID: 27644048 BACKGROUND

• Braus N, Campbell TC, Kwekkeboom KL, Ferguson S, Harvey C, Krupp AE, Lohmeier T, Repplinger MD, Westergaard RP, Jacobs EA, Roberts KF, Ehlenbach WJ. Prospective study of a proactive palliative care rounding intervention in a medical ICU. Intensive Care Med. 2016 Jan;42(1):54-62. doi: 10.1007/s00134-015-4098-1. Epub 2015 Nov 10.

  PMID: 26556622 BACKGROUND

• Ma J, Chi S, Buettner B, Pollard K, Muir M, Kolekar C, Al-Hammadi N, Chen L, Kollef M, Dans M. Early Palliative Care Consultation in the Medical ICU: A Cluster Randomized Crossover Trial. Crit Care Med. 2019 Dec;47(12):1707-1715. doi: 10.1097/CCM.0000000000004016.

  PMID: 31609772 DERIVED

MeSH Terms

Interventions

Palliative Care

Intervention Hierarchy (Ancestors)

Patient Care; Therapeutics; Health Services; Health Care Facilities Workforce and Services

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: OTHER
• Intervention Model: CROSSOVER
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor, Division of Pulmonary and Critical Care Medicine

Study Record Dates

• First Submitted: July 26, 2017
• First Posted: August 28, 2017
• Study Start: August 7, 2017
• Primary Completion: June 9, 2018
• Study Completion: November 30, 2018
• Last Updated: January 24, 2019

Record last verified: 2019-01

Locations

US (1)