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About
The National Academy of Medicine and the National Institutes of Health have called for urgent action to improve the care delivered to the nearly 1,000,000 older Americans who die in intensive care units (ICUs) annually, or survive with substantial impairments. These patients often die with distressing symptoms and may receive more invasive, life-prolonging treatment than they would choose for themselves. Moreover, their family members acting as surrogate decision makers often experience lasting psychological distress from the ICU experience. The investigators will conduct a randomized trial among 500 patients and 750 surrogates and up to 1250 clinicians to determine whether early integration of specialty palliative care with standard critical care can improve outcomes for critically ill older patients at high risk of death or severe functional impairments and their family members.
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Inclusion and exclusion criteria
Patient Inclusion Criteria
Acute:
Chronic:
Admission from a SNF or LTACH with progressive functional decline
Metastatic (stage IV) cancer or advanced cancer without curative treatment
End stage cardiorespiratory disease
End stage liver disease
Advanced dementia or other end-stage neurologic disease
Age greater than or equal to 80 with two or more major comorbidities
Moderate-severe frailty (excluding stable intellectual or physical disability
Patient Exclusion
Surrogate Inclusion
Surrogate Exclusion
Clinician Inclusion
•Patient's primary attending (or their designee)
Primary purpose
Allocation
Interventional model
Masking
2,500 participants in 2 patient groups
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Central trial contact
Rachel A Butler, MHA, MPH; Douglas B White, MD, MAS
Data sourced from clinicaltrials.gov
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