Abstract
Background
Each year, approximately one million older adults die in American intensive care units
(ICUs) or survive with significant functional impairment. Inadequate symptom management,
surrogates’ psychological distress and inappropriate healthcare use are major concerns.
Pioneering work by Dr. J. Randall Curtis paved the way for integrating palliative
care (PC) specialists to address these needs, but convincing proof of efficacy has
not yet been demonstrated.
Design
We will conduct a multicenter patient-randomized efficacy trial of integrated specialty
PC (SPC) vs. usual care for 500 high-risk ICU patients over age 60 and their surrogate
decision-makers from five hospitals in Pennsylvania.
Intervention
The intervention will follow recommended best practices for inpatient PC consultation.
Patients will receive care from a multidisciplinary SPC team within 24 hours of enrollment
that continues until hospital discharge or death. SPC clinicians will meet with patients,
families, and the ICU team every weekday. SPC and ICU clinicians will jointly participate
in proactive family meetings according to a predefined schedule. Patients in the control
arm will receive routine ICU care.
Outcomes
Our primary outcome is patient-centeredness of care, measured using the modified Patient
Perceived Patient-Centeredness of Care scale. Secondary outcomes include surrogates’
psychological symptom burden and health resource utilization. Other outcomes include
patient survival, as well as interprofessional collaboration. We will also conduct
prespecified subgroup analyses using variables such as PC needs, measured by the Needs
of Social Nature, Existential Concerns, Symptoms, and Therapeutic Interaction scale.
Conclusions
This trial will provide robust evidence about the impact of integrating SPC with critical
care on patient, family, and health system outcomes.
Key Words
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Article info
Publication history
Accepted:
February 24,
2022
Identification
Copyright
© 2022 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.