Palliative Care for Critical Illness

Recruiting at 1 trial location

Overseen By Stephen Chi, MD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Washington University School of Medicine

Compensation: Varies

Number of Visits: Unknown

2600 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores whether a hospice and palliative care specialist in a medical intensive care unit (ICU) can improve patient outcomes and reduce healthcare usage. The specialist provides timely and proactive consultations to ICU patients. The study compares the results of patients who receive this care to those who do not and to past patients. Suitable candidates for this trial are individuals currently admitted to a medical ICU at a major referral center. As an unphased trial, this study offers patients the chance to contribute to innovative care practices that could enhance ICU experiences.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that embedding a hospice and palliative care practitioner in an ICU is safe?

Research has shown that hospice and palliative care specialists in intensive care units are safe for patients. One study examined data from nearly 20,000 patients who received hospice or palliative care over three years and found no major safety issues. Instead, patient outcomes improved. This indicates that involving a palliative care expert in patient care does not increase risk.

These findings reassure that involving hospice and palliative care professionals is generally well-accepted. While this trial has a unique approach, existing evidence suggests it is safe. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the embedded hospice and palliative care practitioner approach because it directly integrates specialized care into the medical intensive care unit (ICU) setting. Unlike standard care, which typically involves separate hospice and palliative consultations, this method involves having a dedicated practitioner present in the ICU. This integration aims to provide continuous, personalized support and symptom management for critically ill patients right where they are treated. By potentially improving communication and decision-making, this approach could lead to better patient outcomes and enhanced quality of life during critical illness.

What evidence suggests that embedding a hospice and palliative care practitioner in the ICU could improve patient outcomes?

Research has shown that hospice and palliative care specialists in Intensive Care Units (ICUs) can improve patient outcomes. In this trial, one arm involves a prospective hospice and palliative care intervention where patients receive care from an embedded hospice and palliative care practitioner. A study of nearly 20,000 patients found improvements such as better care planning and more family meetings. Another report found that palliative care teams in ICUs increased the number of consultations and follow-up visits. This approach helps patients and families make informed decisions about care, enhancing their experience during serious illness. Overall, palliative care in ICUs is linked to positive changes that benefit patients with severe health issues. ^{1 6 7 8 9}

Who Is on the Research Team?

Stephen Chi, MD

Principal Investigator

Washington University School of Medicine

Are You a Good Fit for This Trial?

This trial is for patients in a medical intensive care unit (MICU) who may benefit from additional support focused on quality of life and end-of-life issues. There are no specific inclusion or exclusion criteria provided, suggesting it's broadly applicable within the MICU setting.

Inclusion Criteria

Patients admitted to the medical intensive care units at a tertiary referral center

Exclusion Criteria

Not applicable.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

Embedding a hospice and palliative care practitioner within the medical ICU to offer proactive consultations

6 months

Continuous presence in ICU

Follow-up

Participants are monitored for outcomes such as ICU length of stay, code status changes, and healthcare utilization

Up to 1 year

What Are the Treatments Tested in This Trial?

Interventions

• Embedded Hospice and Palliative Care Practitioner

Trial Overview The study is testing if having a dedicated hospice and palliative care practitioner embedded in the MICU improves patient outcomes and healthcare usage compared to standard care without this specialized role.

How Is the Trial Designed?

Group I: Prospective Hospice and Palliative Care Intervention Experimental Treatment 1 Intervention

This arm comprises patients admitted to the specific medical intensive care unit in which the hospice and palliative care practitioner is currently active. This will include all patients admitted to a single medical intensive care unit during the anticipated first half of the intervention timeframe, followed by all patients admitted to both medical intensive care units during the second half of the intervention timeframe.

Group II: Prospective Standard of Care Active Control 1 Intervention

This arm comprises patients admitted to the medical intensive care unit in which the hospice and palliative care practitioner is not currently active, but which may experience a group effect due to the study's ongoing enrollment and the practitioner's presence. This will include all patients admitted to a single medical intensive care unit during the anticipated first half of the intervention timeframe, prior to the practitioner becoming active in both intensive care units.

Group III: Historical Controls Placebo Group 1 Intervention

This arm comprises historical patients admitted to the medical intensive care units in the year prior to study enrollment.

Who Is Running the Clinical Trial?

Washington University School of Medicine

Lead Sponsor

Trials

2,027

Recruited

2,353,000+

Published Research Related to This Trial

Palliative care is recognized as a crucial part of comprehensive treatment for critically ill patients, focusing on patient needs rather than prognosis, and can significantly improve the quality of care in the ICU.

Various effective strategies and resources are available to enhance palliative care in the ICU, which can help patients and families cope with the challenges faced after discharge, highlighting the need for further research to optimize integration and measure outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The changing role of palliative care in the ICU. Aslakson, RA., Curtis, JR., Nelson, JE.[2023]

Palliative care is a comprehensive approach that can be integrated into treatment from the earliest stages of illness, focusing on pain management, psychosocial support, and coordinated care, unlike hospice care which is limited to patients expected to die within 6 months.

Recent developments in palliative care for oncology include improved management strategies for issues like malignant small bowel obstruction and enhanced communication practices for patient preferences and advanced-care planning, emphasizing the importance of ethical considerations in end-of-life care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Changing perspectives on palliative care. Choi, YS., Billings, JA.[2006]

A survey of 195 respondents in a Midwest community revealed a strong perceived need for palliative care services, especially for individuals with chronic illnesses who do not meet traditional hospice criteria.

While healthcare professionals felt comfortable providing palliative care, they noted that such services were not widely available, and there were concerns about patients' willingness to accept care from hospice organizations, despite lay individuals expressing openness to these services if covered by insurance.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A community needs assessment for palliative care services from a hospice organization. Kwekkeboom, K.[2014]

A study analyzing 475 serious incident reports in palliative care over 12 years revealed that the most common issues were pressure ulcers (266 reports) and medication errors (91 reports), highlighting significant safety risks in this vulnerable population.

The analysis identified key causes of unsafe care, including lack of palliative care experience and poor service coordination, suggesting that enhancing care delivery and increasing access to specialist support could help reduce these risks and improve patient outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Patient safety in palliative care: A mixed-methods study of reports to a national database of serious incidents. Yardley, I., Yardley, S., Williams, H., et al.[2019]

Patients in critical condition often require intensive care and rarely die at home, highlighting the growing need for hospice and palliative care (PC) in the ICU setting.

Palliative care is essential for various patient groups in the ICU, including those with chronic critical illnesses, elderly patients, and those with poor prognoses, and effective interdisciplinary collaboration between ICU teams and PC specialists is crucial for improving care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Hospice and Palliative Care for Patients in the Intensive Care Unit: Current Status in Countries Other than Korea. Jung, M.[2023]

A study analyzing data from 19,747 hospice/palliative care patients over three years showed significant improvements in various patient outcomes, including symptom control and family care, although pain management did not improve.

The findings indicate that systematic data collection and feedback have led to better and more consistent patient outcomes in hospice/palliative care services across Australia.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improving national hospice/palliative care service symptom outcomes systematically through point-of-care data collection, structured feedback and benchmarking. Currow, DC., Allingham, S., Yates, P., et al.[2021]

A quality assurance program for palliative care, initiated in 1999, analyzed data from 4693 inpatient treatment periods, highlighting the unique therapeutic needs and interdisciplinary care of palliative patients.

The study found that while palliative care units maintain consistent quality traits, they face challenges in pain management and patient outcomes compared to oncologic and geriatric wards, indicating the need for standardized documentation to improve care quality.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Quality assurance in palliative medicine--results of the core documentation of 1999-2002]. Lindena, G., Nauck, F., Bausewein, C., et al.[2022]

In a study of 65 hospice and palliative care patients, 78% had events that led to their admission, and 62% experienced additional adverse events during their stay, highlighting the prevalence of symptomatic adverse events in this population.

The study found an average of 0.13 adverse events per patient per day, indicating that even in the absence of initial events, patients are at high risk for complications, which can worsen their overall health status.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adverse events in hospice and palliative care: a pilot study to determine feasibility of collection and baseline rates. Currow, DC., Agar, MR., To, TH., et al.[2011]

A consensus process led to the development of 18 preliminary quality measures for assessing palliative care in critically ill patients, focusing on both process and structural aspects of care.

The majority of these measures (14) evaluate the processes of care at the patient level, highlighting the need for future research to link these measures to health outcomes and patient satisfaction.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Proposed quality measures for palliative care in the critically ill: a consensus from the Robert Wood Johnson Foundation Critical Care Workgroup. Mularski, RA., Curtis, JR., Billings, JA., et al.[2020]

A palliative care intervention for patients with end-stage liver disease showed a significant reduction in the risk of hospital readmission, with a hazard ratio of 0.36, indicating that patients receiving this intervention were less likely to be readmitted compared to those receiving usual care.

Patients in the intervention group also experienced more days alive outside the hospital, with an odds ratio of 3.97, suggesting that palliative care can improve quality of life even in the context of serious illness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

COMPASS: A Pilot Trial of an Early Palliative Care Intervention for Patients With End-Stage Liver Disease. Shinall, MC., Karlekar, M., Martin, S., et al.[2021]

Telehospice and telepalliative care utilize telehealth services to provide remote support for patients, focusing on pain management and emotional needs, which can enhance the overall quality of care.

These telehealth interventions allow for timely assessments and interventions, improving patient compliance and offering more educational opportunities for caregivers, ultimately addressing both patient and caregiver needs effectively.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Telehealth in Hospice and Palliative Care. Cox, S.[2022]

Palliative care programs in hospitals significantly enhance the quality of care for seriously ill patients, leading to shorter hospital stays and higher patient satisfaction.

The most effective palliative care outcomes are achieved through multidisciplinary teams, highlighting the importance of coordinated care among healthcare providers.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Growth of hospital-based palliative care programs surges. [2018]

In Australia, over 85% of patients referred to specialized hospice/palliative care services have cancer, highlighting the importance of these services in cancer care, with data collected from 5,395 patients across 6,379 admissions.

The Palliative Care Outcomes Collaboration (PCOC) revealed significant variations in patient outcomes, such as stability after an unstable phase (12-fold differences) and improvements in symptom scores (seven-fold differences), indicating the need for ongoing data collection and benchmarking in palliative care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Is it feasible and desirable to collect voluntarily quality and outcome data nationally in palliative oncology care? Currow, DC., Eagar, K., Aoun, S., et al.[2008]

Citations

1. reports.mountsinai.org reports.mountsinai.org/article/gpm2024-a-system-wide-approach-embedding-palliative-care-teams

Embedding Palliative Care Teams in ICUs to Improve ... Read about the Brookdale Department embedding palliative care teams in ICUs to improve outcomes.

2. sciencedirect.com sciencedirect.com/science/article/abs/pii/S1555415523000053

The Impact of Embedding a Palliative Care Advance ... A palliative care nurse practitioner was embedded on the neuroscience ICU team; in doing so, the number of consults, family meetings, and follow-up visits ...

3. withpower.com withpower.com/trial/phase-quality-of-life-qol-6-2024-118e6

Palliative Care for Critical Illness A study analyzing data from 19,747 hospice/palliative care patients over three years showed significant improvements in various patient outcomes, including ...

4. jpsmjournal.com jpsmjournal.com/article/S0885-3924(22)01043-0/pdf

Lessons Learned from an Embedded Palliative Care ... Using the electronic health record data, we compared palliative care consultation characteristics, rates of documentation of medical decision- ...

5. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10519717/

Hospice and Palliative Care for Patients in the Intensive ... Hospice and palliative care (PC) is necessary for all patients with life-threatening diseases. The following patients need palliative care in the ICU.

6. scorecard.capc.org scorecard.capc.org/

CAPC's 2024 Serious Illness Scorecard - Explore State Ratings America's Serious Illness Scorecard reviews each state's capacity to deliver high-quality care to people facing serious illness.

7. aacnjournals.org aacnjournals.org/aacnacconline/article/35/2/157/32476/Innovative-Strategies-for-Palliative-Care-in-the

Innovative Strategies for Palliative Care in the Intensive Care ... This article reviews 2 evidence-based practice projects, a serious illness support tool and the 3 Wishes Project, to add to the palliative care toolkit.

8. liebertpub.com liebertpub.com/doi/10.1089/pmr.2025.0030

A Strategic Path Forward for Hospice and Palliative Care This path forward addresses the hard problems the field faces and enables it to realize its dual mission of caring well for ill and dying people.

9. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0735675723006307

Emergency department hospice care pathway associated ... This non-interruptive, digitally embedded clinical care pathway provided guidance for ED physicians and APPs to initiate hospice referrals.