Palliative Care Consultations in the Skilled Nursing Facility (SNF) Setting

University of Maryland Baltimore (UMB)

Status: Completed

Conditions: Advance Care Planning; Skilled Nursing Facilities; Palliative Care

Treatments: Other: Palliative Care Consultation

Study type: Interventional

Funder types: Other

Identifiers

NCT03958552

HP-00099506

Details and patient eligibility

About

Close to one-third of Medicare decedents use the Medicare skilled nursing facility (SNF) benefit in the 6 months prior to death. SNF care often increases the risk for more aggressive, potentially burdensome treatments and unrecognized or undertreated symptoms. Palliative care is goal-directed, patient and family-centered care that focuses on a wide range of physical, psychosocial, and spiritual needs for persons with serious, life-limiting illnesses. Effective palliative care relieves suffering, enhances communication, and improves end-of-life care and decision making for seriously ill older adults. Despite its association with improved quality of care, higher satisfaction, and better symptom management at the end of life, palliative care is not widely available to Medicare patients in the Skilled Nursing Facility (SNF) setting. Palliative care consultation (PCC) is one approach that can potentially improve care for older adults with advanced illness in SNFs. This pilot study will test an evidence-based palliative care consult intervention for older adult SNF patients in nursing homes by comparing the patient/family caregiver reported quality of life in two participant groups: one receiving a PCC and the other receiving standard care.

Enrollment: 45 patients

Sex: All

Ages: 60+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Admitted to a participating nursing home under the Medicare SNF benefit
• English speaking
• If non-verbal or unable to participate in a conversation, a legally authorized representative(LAR) or surrogate decision maker who can participate in the study
• A diagnosis of one or more advanced serious illness using established criteria
• One global indicator for a PCC at SNF admission (i.e., primary provider would not be surprised if patient died in 12 months; frequent hospital or SNF admissions; complex care requirements; decline in function; feeding intolerance; or unintended decline in weight)

Exclusion criteria

• Patients who have previously received or are referred for a SNF-based PCC by their primary care team

Trial design

Primary purpose: Supportive Care

Allocation: Non-Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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45 participants in 2 patient groups

Standard Care

No Intervention group

Description:

Participants will receive the standard Medicare Skilled Nursing Facility care.

Palliative Care Consult

Experimental group

Description:

Participants will receive the standard Medicare Skilled Nursing Facility care plus a Palliative Care Consultation with a trained provider.

Treatment:

Other: Palliative Care Consultation