Surprise Question in End of Life (SeQuEL) Care and the Effect of Prompting Palliative Care Consultation: End-Stage Liver Disease

NCT06400498 | Completed

• 1 other identifier: 240233
• Study Type: interventional
• Target: 97
• Locations: 1 country
• Sites: 1

Brief Summary

This is a single center randomized platform trial determining whether prompting consideration of palliative care consultation through the electronic health record impacts the number of palliative consultations placed and hospital-free days among hospitalized adults with End-Stage Liver Disease.

Conditions

End-Stage Liver Disease

Keywords

Palliative Care

Outcome Measures

Primary Outcomes (2)

• Percentage of patients with palliative care consults placed within 48 hours after enrollment

  Percentage of patients identified within the EHR identified with palliative care consults.

  48 hours post-enrollment

• Hospital-free days by day 90

  The number of calendar days between enrollment and day 90 in which the patient is alive and outside of an acute-care hospital. Days spent at home, at a rehabilitation facility, at a nursing facility, and at an inpatient hospice facility will count as hospital-free.

  90 days post-enrollment

Secondary Outcomes (1)

• Survival to day 90

  90 days post-enrollment

Study Arms (2)

No Palliative Care Consultation Prompt Group

NO INTERVENTION

When a patient is randomized to the No Palliative Care Consultation Prompt Group, no prompt will occur. A treating clinician can choose to place or discontinue a palliative care consultation at any time. A patient may choose to request or decline a palliative care consultation at any time.

Palliative Care Consultation Prompt Group

ACTIVE COMPARATOR

When a patient is randomized to the Palliative Care Consultation Prompt Group, a clinical decision support tool in the electronic health record will inform the treating clinician of the patient's serious illness and the results of the Surprise Question and prompt the treating clinician to consider a palliative care consultation. A treating clinician can choose to place or discontinue a palliative care consultation at any time, retaining full autonomy to deliver the appropriate patient care. A patient may choose to request or decline a palliative care consultation at any time.

Behavioral: Prompted Palliative Care Consult

Interventions

Prompted Palliative Care Consult BEHAVIORAL

When a patient is randomized to the Palliative Care Consultation Prompt Group, a clinical decision support tool in the electronic health record will inform the treating clinician of the patient's serious illness and the results of the Surprise Question and prompt the treating clinician to consider a palliative care consultation. If the treating clinician feels a palliative care consultation would be indicated for the patient, the clinical decision support tool will facilitate the placement of a palliative care consultation by the treating clinician. If the treating clinician feels that a palliative care consultation would not be indicated, then the clinical decision support will record a reason it is not indicated.

Palliative Care Consultation Prompt Group

Eligibility Criteria

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

You may qualify if:

• Patient is an adult (age ≥ 18 years).
• Patient is admitted to the study hospital.
• Patient meets phenotype criteria for End-Stage Liver Disease.
• Patient's treating physician, physician associate, or nurse practitioner answers "No" to a prompt in the electronic health record asking, "Would you be surprised if this patient died in the next 12 months?"

You may not qualify if:

• Patient is known to have received any VUMC palliative care consultation during the prior 3 months and/or the current admission.
• Patient is known to be a prisoner.
• Patient has received a liver transplant.

Sponsors & Collaborators

• Vanderbilt University Medical Center: lead

Study Sites (1)

Vanderbilt University Medical Center

Nashville, Tennessee, 37232, United States

Location

Related Publications (10)

• Ferrell BR, Twaddle ML, Melnick A, Meier DE. National Consensus Project Clinical Practice Guidelines for Quality Palliative Care Guidelines, 4th Edition. J Palliat Med. 2018 Dec;21(12):1684-1689. doi: 10.1089/jpm.2018.0431. Epub 2018 Sep 4.

  PMID: 30179523 BACKGROUND

• Reframing Palliative Care | Messages Matter | On-Demand Webinar.; 2017. https://www.capc.org/events/recorded-webinars/reframing-palliative-care-messages-matter/

  BACKGROUND

• Radbruch L, De Lima L, Knaul F, Wenk R, Ali Z, Bhatnaghar S, Blanchard C, Bruera E, Buitrago R, Burla C, Callaway M, Munyoro EC, Centeno C, Cleary J, Connor S, Davaasuren O, Downing J, Foley K, Goh C, Gomez-Garcia W, Harding R, Khan QT, Larkin P, Leng M, Luyirika E, Marston J, Moine S, Osman H, Pettus K, Puchalski C, Rajagopal MR, Spence D, Spruijt O, Venkateswaran C, Wee B, Woodruff R, Yong J, Pastrana T. Redefining Palliative Care-A New Consensus-Based Definition. J Pain Symptom Manage. 2020 Oct;60(4):754-764. doi: 10.1016/j.jpainsymman.2020.04.027. Epub 2020 May 6.

  PMID: 32387576 BACKGROUND

• Baumann AJ, Wheeler DS, James M, Turner R, Siegel A, Navarro VJ. Benefit of Early Palliative Care Intervention in End-Stage Liver Disease Patients Awaiting Liver Transplantation. J Pain Symptom Manage. 2015 Dec;50(6):882-6.e2. doi: 10.1016/j.jpainsymman.2015.07.014. Epub 2015 Aug 22.

  PMID: 26303186 BACKGROUND

• Rogal SS, Hansen L, Patel A, Ufere NN, Verma M, Woodrell CD, Kanwal F. AASLD Practice Guidance: Palliative care and symptom-based management in decompensated cirrhosis. Hepatology. 2022 Sep;76(3):819-853. doi: 10.1002/hep.32378. Epub 2022 Apr 22. No abstract available.

  PMID: 35103995 BACKGROUND

• Holden JH, Shamseddeen H, Johnson AW, Byriel B, Subramoney K, Cheng YW, Saito A, Ghabril M, Chalasani N, Sachs GA, Orman ES. Palliative Care and Hospice Referrals in Patients with Decompensated Cirrhosis: What Factors Are Important? J Palliat Med. 2020 Aug;23(8):1066-1075. doi: 10.1089/jpm.2019.0501. Epub 2020 Feb 24.

  PMID: 32091954 BACKGROUND

• Woodrell CD, Goldstein NE, Moreno JR, Schiano TD, Schwartz ME, Garrido MM. Inpatient Specialty-Level Palliative Care Is Delivered Late in the Course of Hepatocellular Carcinoma and Associated With Lower Hazard of Hospital Readmission. J Pain Symptom Manage. 2021 May;61(5):940-947.e3. doi: 10.1016/j.jpainsymman.2020.09.040. Epub 2020 Oct 6.

  PMID: 33035651 BACKGROUND

• Shinall MC Jr, Karlekar M, Martin S, Gatto CL, Misra S, Chung CY, Porayko MK, Scanga AE, Schneider NJ, Ely EW, Pulley JM, Jerome RN, Dear ML, Conway D, Buie R, Liu D, Lindsell CJ, Bernard GR. COMPASS: A Pilot Trial of an Early Palliative Care Intervention for Patients With End-Stage Liver Disease. J Pain Symptom Manage. 2019 Oct;58(4):614-622.e3. doi: 10.1016/j.jpainsymman.2019.06.023. Epub 2019 Jul 2.

  PMID: 31276810 BACKGROUND

• Moroni M, Zocchi D, Bolognesi D, Abernethy A, Rondelli R, Savorani G, Salera M, Dall'Olio FG, Galli G, Biasco G; on behalf of the SUQ-P group. The 'surprise' question in advanced cancer patients: A prospective study among general practitioners. Palliat Med. 2014 Jul;28(7):959-964. doi: 10.1177/0269216314526273. Epub 2014 Mar 24.

  PMID: 24662237 BACKGROUND

• Moss AH, Ganjoo J, Sharma S, Gansor J, Senft S, Weaner B, Dalton C, MacKay K, Pellegrino B, Anantharaman P, Schmidt R. Utility of the "surprise" question to identify dialysis patients with high mortality. Clin J Am Soc Nephrol. 2008 Sep;3(5):1379-84. doi: 10.2215/CJN.00940208. Epub 2008 Jul 2.

  PMID: 18596118 BACKGROUND

MeSH Terms

Conditions

End Stage Liver Disease

Condition Hierarchy (Ancestors)

Liver Failure; Hepatic Insufficiency; Liver Diseases; Digestive System Diseases

Study Officials

• Mohana Karlekar, MD

  Vanderbilt University Medical Center

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: SUPPORTIVE CARE
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate Professor of Medicine, Division of General Internal Medicine and Public Health, MD, FACP, FAAHPM

Model Details: This study will be performed as a single center, pragmatic, randomized clinical trial.

Study Record Dates

• First Submitted: May 1, 2024
• First Posted: May 6, 2024
• Study Start: August 5, 2024
• Primary Completion: May 5, 2025
• Study Completion: August 5, 2025
• Last Updated: August 19, 2025

Record last verified: 2025-08

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP
• Time Frame: The data will become available 3 months following publication of outcomes and will remain available for at least 5 years.
• Access Criteria: Data will be made available to researchers who provide a methodologically sound proposal that has been approved by the Vanderbilt Institutional Review Board and the study executive committee.

Locations

US (1)