Timing of Acute Palliative Care Consultation in Critically Ill Patients

Wayne State University

Status: Unknown

Conditions: End Stage Cardiac Failure; Multiple Organ Failure; Hepatic Encephalopathy; Multiple Sclerosis; In-Hospital Cardiac Arrest; Parkinson's Disease; Solid Organ Cancer; Dementia; Chronic Kidney Disease Stage 5; Sepsis; End Stage Chronic Obstructive Airways Disease

Treatments: Other: Early order of palliative care consultation

Study type: Interventional

Funder types: Other

Identifiers

NCT02858778

BCBSMF PSACO

Details and patient eligibility

About

A prospective randomized controlled trial studying the ordering of palliative care consultations in the emergency department (Ig) versus later palliative care consultations in the hospital--ICU or hospital ward(Cg). Patients will be randomly allocated to Ig or Cg with a 1:1 ratio.

Enrollment: 120 estimated patients

Sex: All

Ages: 65+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Greater than or equal to 65 years old
• Treated in a resuscitation room for unstable vital signs or respiratory compromise
• One or more of the following:
• Advanced or metastatic solid organ cancer
• End stage organ failure of the heart, lung/COPD, kidney on dialysis, hepatic encephalopathy
• Suspected sepsis
• Advanced dementia, end-state multiple sclerosis or Parkinson's disease
• Status post cardiac arrest with coma (Glascow coma score <7)
• Patient is from a skilled nursing facility

Exclusion criteria

• Lack decision capacity and have no relative available during ED stay to consent to the study (legally authorized representative-LAR)
• Enrolled in hospice care prior to randomization
• A copy of a completed advance directive which names a designated proxy provided physically to the medical team prior to randomization
• Wearing a DNR bracelet
• Have been previously enrolled in this study

Trial design

Primary purpose: Supportive Care

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

---

120 participants in 2 patient groups

Interventional group (Ig)

Experimental group

Description:

The interventional group (Ig) will have an early palliative care consultation ordered during their stay in the emergency department.

Treatment:

Other: Early order of palliative care consultation

Control group (Cg)

No Intervention group

Description:

The control group will be treated as standard of care. Palliative care consultations may or may not be ordered at the attending physician's discretion.