Behavioral Nudges to Improve Palliative Care Utilization in Advanced Cancer

NCT05365997 | Completed Results DMC

• 2 other identifiers: UPCC 29921849498
• Study Type: interventional
• Target: 266
• Locations: 1 country
• Sites: 1

Brief Summary

Patients with cancer often undergo costly therapy and acute care utilization that is discordant with their wishes, particularly at the end of life. Despite early palliative care consultations being a National Comprehensive Cancer Network (NCCN) guideline-concordant practice in advanced cancer, palliative care referral rates for stage IV patients are low. In this project, the investigators will evaluate a health system initiative that uses behavioral nudges to prompt palliative care referrals among outpatients with advanced cancer in terms of successful palliative care referrals and downstream quality of life outcomes. In partnership with the health system, this will be conducted as a 2-arm pragmatic cluster randomized trial.

Conditions

Cancer

Keywords

Cancer; Palliative Care; Behavioral Economics

Outcome Measures

Primary Outcomes (1)

• Completion of Palliative Care Visit

  Binary outcome (yes/no) measured at the patient level among eligible patients based on the date of documented palliative care encounter

  Within 12 weeks of the Index Visit

Study Arms (2)

Control

NO INTERVENTION

Clinicians will receive no further interventions beyond usual practice.

Intervention

EXPERIMENTAL

Clinicians receive a nudge consisting of an electronic health record in-basket message indicating a patient has a default pended order for palliative care.

Other: Default Nudge

Interventions

Default Nudge OTHER

For patients whose clinician pods are randomized to the intervention arm, the care team pod will receive a message indicating that the patient is eligible for palliative care and that a default referral order has been pended for that patient. Clinicians will be given an opportunity to respond if they do not want their patient to be referred to palliative care. For clinicians who do not respond, after the allotted time, the Clinical Research Coordinator will reach out to the patient to introduce palliative care and ask if staff can schedule an appointment. For clinicians who respond no, the pended order will be removed and no patient contact by the research team will occur.

Intervention

Eligibility Criteria

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

You may qualify if:

• Have a functional telephone number
• Receive ongoing care from hematology/oncology services within the Ann B. Barshinger Cancer Institute (ABBCI) at Lancaster General Health.

You may not qualify if:

• Patients appearing for a new patient visit
• Patients who have previously received palliative care
• Patients who are enrolled in an ongoing clinical trial of a therapeutic agent
• Patients who receive primary oncologic care within another institution

Sponsors & Collaborators

• Abramson Cancer Center at Penn Medicine: lead

Study Sites (1)

Ann B. Barshinger Cancer Institute at Lancaster General Health

Lancaster, Pennsylvania, 17601, United States

Location

Related Publications (1)

• Parikh RB, Sedhom R, Ferrell WJ, Villarin K, Berwanger K, Scarborough B, Oyer R, Kumar P, Ganta N, Sivendran S, Chen J, Volpp KG, Bekelman JE. Behavioural economic interventions to embed palliative care in community oncology (BE-EPIC): study protocol for the BE-EPIC randomised controlled trial. BMJ Open. 2023 Mar 24;13(3):e069468. doi: 10.1136/bmjopen-2022-069468.

  PMID: 36963789 DERIVED

MeSH Terms

Conditions

Neoplasms

Results Point of Contact

• Title: Dr. Ravi Parikh
• Organization: University of Pennsylvania

ravi.parikh@pennmedicine.upenn.edu

3524224285

Study Officials

• Ravi Parikh, MD, MPP

  Penn/ACC

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: No
• Restrictive Agreement: No

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: INVESTIGATOR
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: Each clinician pod will be randomized in a 1:1 fashion to either intervention or usual care.

Study Record Dates

• First Submitted: May 4, 2022
• First Posted: May 9, 2022
• Study Start: May 23, 2022
• Primary Completion: February 20, 2023
• Study Completion: August 8, 2023
• Last Updated: February 5, 2025
• Results First Posted: February 5, 2025

Record last verified: 2025-01

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)