CLINICAL TRIAL

Early order of palliative care consultation for Airflow Obstruction, Chronic

Waitlist Available · 65+ · All Sexes · Detroit, MI

This study is evaluating whether palliative care consultations should be done in the emergency department or later in the hospital.

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About the trial for Airflow Obstruction, Chronic

Eligible Conditions
Parkinson Disease · Hepatic Encephalopathy · Lung Diseases, Obstructive · Dementia · Multiple Sclerosis · Renal Insufficiency, Chronic · Brain Diseases · Heart Failure · Solid Organ Cancers · Parkinson's Disease (PD) · End Stage Cardiac Failure · Kidney Diseases · Pulmonary Disease, Chronic Obstructive · Multiple Organ Failure · Inhospital Cardiac Arrest · End Stage Chronic Obstructive Airways Disease · hemodialysis-dependent chronic kidney disease (HDD-CKD) · Sepsis

Treatment Groups

This trial involves 2 different treatments. Early Order Of Palliative Care Consultation is the primary treatment being studied. Participants will all receive the same treatment. There is no placebo group. The treatments being tested are not being studied for commercial purposes.

Main TreatmentA portion of participants receive this new treatment to see if it outperforms the control.
Early order of palliative care consultation
OTHER
Control TreatmentAnother portion of participants receive the standard treatment to act as a baseline.

Eligibility

This trial is for patients born any sex aged 65 and older. There are 8 eligibility criteria to participate in this trial as listed below.

Inclusion & Exclusion Checklist
Mark “yes” if the following statements are true for you:
, severe malnutrition The individual has a very poor prognosis with end stage organ failure of the heart, lung/COPD, kidney on dialysis, hepatic encephalopathy, and severe malnutrition. show original
The patient suffered a cardiac arrest, and is now in a coma with a Glasgow coma score of less than seven. show original
The patient is from a skilled nursing facility and has been admitted to the hospital with a diagnosis of cellulitis of the right lower extremity. show original
, patients who were administered naloxone did not require any additional intervention, including mechanical ventilation Patients who received naloxone in a resuscitation room for unstable vital signs or respiratory compromise did not require any additional intervention, including mechanical ventilation. show original
Greater than or equal to 65 years old
Advanced or metastatic solid organ cancer
Advanced dementia, end-state multiple sclerosis or Parkinson's disease
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Odds of Eligibility
Unknown<50%
Be sure to apply to 2-3 other trials, as you have a low likelihood of qualifying for this one.Apply To This Trial

Approximate Timelines

Please note that timelines for treatment and screening will vary by patient
Screening: ~3 weeks
Treatment: varies
Reporting: 1 year
This trial has approximate timelines as follows: 3 weeks for initial screening, variable treatment timelines, and reporting: 1 year.
View detailed reporting requirements
Trial Expert
Connect with the researchersHop on a 15 minute call & ask questions about:
- What options you have available- The pros & cons of this trial
- Whether you're likely to qualify- What the enrollment process looks like

Measurement Requirements

This trial is evaluating whether Early order of palliative care consultation will improve 1 primary outcome and 9 secondary outcomes in patients with Airflow Obstruction, Chronic. Measurement will happen over the course of 30 days from enrolled patients' hospital discharge.

The proportion of billed CMS ACP-CPT codes in Ig vs. Cg
30 DAYS FROM ENROLLED PATIENTS' HOSPITAL DISCHARGE
The proportion of patients who received an ACP CMS billing codes (which took effect in January 2016), in Ig vs. Cg will be evaluated using one or both of the new CPT codes for Advance care planning (ACP) services…including the explanation and discussion of advance directives such as standard forms (with the completion of such forms, when performed) by the physician or other qualified health profession; first 30 (15-45)minutes, face to face with the patients, family member(s) and/or surrogate Code 99497; and each additional 30 (46-75 minutes)-Code 99498 (Federal Register, 2015).
Patient/family satisfaction with care in Ig vs. Cg
BASELINE
This outcome will be measured on a continuous scale. The net-promoter score will be measured at baseline (at randomization) and at hospital discharge for a change in value. It is measured on a scale of 1-10. Whoever signs the consent (patient of LAR) will be asked the net promoter score, and that will be reassessed by them at discharge, unless the patient has died-and the variable will then be recorded as missing. The PSQ will be administered by research assistants at the time of the patient's discharge. If the patient is incapacitated, then it will be asked of the patient's closest family caregiver. So PSQ is only at discharge of patient or available, most involved, family caregiver.
Hospital total direct costs for the index visit in Ig vs. Cg
1 YEAR
The difference in the percentage of patients with a completed advance directive (AD) in Ig vs.Cg
1 YEAR
Average days in hospice in Ig vs. Cg
1 YEAR
Time to consultation in Ig vs. Cg groups
1 YEAR
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Who is running the study

Principal Investigator
R. Z.
Robert Zalenski, Principle Investigator
Wayne State University

Patient Q & A Section

Please Note: These questions and answers are submitted by anonymous patients, and have not been verified by our internal team.

What causes airflow obstruction, chronic?

A variety of conditions can lead to airflow obstruction, including inflammation and scars. Chronic airflow obstruction is a specific syndrome, and it is more severe than chronic bronchitis or emphysema.

Anonymous Patient Answer

What is airflow obstruction, chronic?

At least two thirds of patients presenting to an ENT or ENT/laryngology (ENTL) practice have airflow obstruction, which is associated with significant morbidity and substantial costs. The differential diagnosis of AAFO should be improved.

Anonymous Patient Answer

What are the signs of airflow obstruction, chronic?

A persistent cough is the most common symptom, and is often the initial sign of airflow obstruction. Other symptoms relate to the intensity of the cough and the amount of sputum produced. Coughing can also be a sign of airway obstruction, and the presence of sputum can often be an indicator of the presence of lung disease. However, in the absence of a history of cough of long duration, lung nodules or emphysema are suggestive of airflow obstruction, and in the absence of cough, the chest X-ray may reveal abnormalities in the lung parenchyma.

Anonymous Patient Answer

Can airflow obstruction, chronic be cured?

There is no evidence in the current literature supporting the thesis that airflow obstruction, chronic is actually cure or that it is even possible to permanently eliminate symptoms through medical management of airflow obstruction.

Anonymous Patient Answer

What are common treatments for airflow obstruction, chronic?

The treatment of choice for chronic airflow obstruction depends on the severity of the symptoms and the functional disability it causes. Common treatments include inhalation of oxygen alone, a low-dose ciclosporin (CyC) treatment, and a combination of CyC and ciprofloxacin.

Anonymous Patient Answer

How many people get airflow obstruction, chronic a year in the United States?

About 1.2 million people will be diagnosed with airflow obstruction, chronic in the United States in 2024, and one-half the people will receive COPD-specific treatment.

Anonymous Patient Answer

Have there been other clinical trials involving early order of palliative care consultation?

Palliative care consultations on acute palliative care consult day 2, and day 4 in the dying patient seem to have a clinical effectiveness; thus an early palliative care consultation (within the first 24 hours post admission) does not seem to be indicated. This was indicated by the high percentage of patients' selfreported comfort and symptom relief.

Anonymous Patient Answer

How does early order of palliative care consultation work?

Results from a recent clinical trial are encouraging, and may in time lead to greater palliative care provision to those previously overlooked in care plans and services. While some limitations to this study exist, the findings suggest early palliative care consultations may improve quality of life of patients with advanced disease, warrant further investigation.

Anonymous Patient Answer

What is early order of palliative care consultation?

Early consultation in a patient with advanced cancer before dyspnea is present is not necessarily in the patient's or their family's interest. It is often in the physician's. Early and timely palliative care consultation seems to lead to less aggressive symptom management, enhanced quality of life, improved outcomes including symptom relief and increased length of survival even after first-line treatment.

Anonymous Patient Answer

How serious can airflow obstruction, chronic be?

Most patients with chronic airflow obstruction suffer from serious consequences, including chronic bronchitis and emphysema, and this may be due to long sitting in a squatting position during work. Those with COPD-related airflow obstruction should be encouraged and supported to improve their walking capacity with and without exertion, as well as to lose weight and decrease the risk of comorbid and potentially serious medical complications.

Anonymous Patient Answer

What is the average age someone gets airflow obstruction, chronic?

Age is not the only factor related to airflow obstruction. The average age of onset in women was approximately 15 years earlier than in men. The reasons for this may include an earlier exposure to the agent causing the pathophysiology, women being exposed to more occupational and environmental hazards, and women developing airflow obstruction later than men. These observations may also suggest that lung function declines over a relatively longer period in women than men.

Anonymous Patient Answer

Have there been any new discoveries for treating airflow obstruction, chronic?

Since a combination of bronchodilators has been the most commonly used treatment, it seems prudent to consider this approach first when trying to treat COPD patients in the emergency department.

Anonymous Patient Answer
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