Improving Palliative Care Access Through Technology
- Conditions
- Palliative CareTelehealth
- Interventions
- Other: Telehealth visit
- Registration Number
- NCT04969484
- Lead Sponsor
- University of Utah
- Brief Summary
This project will focus on developing, optimizing and pilot-testing a multi-component Improving Access Through Technology (ImPAcTT) intervention that leverages existing telehealth technologies to provide staff education; family outreach, engagement and support; care coordination; and resident symptom management and facilitation of goals-of-care discussion.
- Detailed Description
Almost 1.8 million older Americans live in nursing homes (NH), with estimates that this number will grow to more than 3 million by 2050. NHs are increasingly becoming the place of care and site of death for frail older adults dying from multiple chronic illnesses. Unfortunately, most residents die without the benefit of palliative care (PC) or with palliation delayed until the last days of life.
Unfortunately, hospice services are often the only formal end of life care service available in NHs, and access to hospice enrollment is complicated by financial implications for both NHs and residents.
Telehealth, or remote monitoring of patients through information and communication technologies, is an effective mechanism for addressing the increased demand on health services and has much to offer to people living with and dying from advanced illness. Moreover, numerous studies have demonstrated positive benefits of using telehealth in the NH to improve access to consultants (e.g., neurology, dermatology, psychiatry).
Little is known, however, about the effect of using Telehealth on improving access to PC specialists in the NH setting.
The proposed ImPAcTT intervention employs a secure communications platform that permits multi-person live video, audio, and text message consultations; real-time document sharing and documentation for advanced care planning discussions; and remote virtual assessment capabilities.
The investigator will conduct a pilot implementation trial of ImPAcTT in 3 study nursing homes to evaluate our ability to safely recruit and retain study participants, collect appropriate and accurate data, and determine preliminary estimates of an effect size of the intervention.
Recruitment & Eligibility
- Status
- SUSPENDED
- Sex
- All
- Target Recruitment
- 81
Not provided
Not provided
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description ImPAcTT intervention Telehealth visit Within 48-72 hours of enrollment in the study, the primary participant and family will receive an ImPAcTT Telehealth visit with the PC provider. The provider will conduct a comprehensive PC assessment aligned with the National Consensus Project for Quality Palliative Care guidelines. Visits, which may include remote physical assessment using a digital stethoscope, dermatoscope, etc., will be documented and transmitted to the NH. Advanced Care Planning (ACP) and goals of care discussions will be facilitated by the ability to virtually share and edit documents, such as the Physician Orders for Life Sustaining Treatment (POLST), in real time with primary participants and/or family. The PC provider will conduct follow-up visits 1 week following the initial visit, then on a case-by-case basis.
- Primary Outcome Measures
Name Time Method Change in Symptom distress (composite measure) Baseline and Last visit -12 weeks Symptom distress as measured by the Edmonton Symptom Assessment Scale - ESAS
* ESAS physical score (total of physical 6 symptoms, score range 0-60)
* ESAS emotional score (total of 2 emotional symptoms, score range 0-60)
* ESAS total symptom distress score (physical score + emotional score + well being)
For all symptom distress scores:
High score means: worst outcome Low score means: better outcomeChange in Symptom impact Baseline and Last visit -12 weeks Symptom impact as measured by the "Quality of Life at the End of Life" - QUAL-E
Symptom impact subscale:
Minimum value: 3 Maximum value: 15
High score means: worst outcome Low score means: better outcome
- Secondary Outcome Measures
Name Time Method Change in number of completed POLST forms Baseline and Last visit -12 weeks Number of Physician's Orders for Life-Sustaining Treatment - POLST forms completed
Number of residents transitioned to hospice Last visit - week 12 Number of residents transitioned to hospice
Number of In-hospital death Baseline and Last visit -12 weeks Number of In-hospital death
Change in Functional Status Baseline and Last visit -12 weeks Functional Status as measured by the PalliativePerformance Scale (PPSv2)
Minimum value: 0% Maximum value: 100%
High score means: better outcome Low score means: worst outcomeChange in Mortality Baseline and Last visit -12 weeks Risk for dying within one year as measured by the Flacker Mortality Score
Minimum value: 0 Maximum value: 15.21
High score means: worst outcome Low score means: better outcomeChange in Family Satisfaction Baseline and Last visit -12 weeks Family Satisfaction as measured by the "Quality of Life at the End of Life - Family" - QUAL-E Fam
Subscale: Relationship with Healthcare Provider \[Questions #5-8 with 5 item Likert scales, average of 4 scores\] Minimum value: 1 Maximum value: 5
High score means: worst outcome Low score means: better outcomeChange in acute care utilization (composite measure) Baseline and Last visit -12 weeks Number of ED Visits and number of Hospitalizations
Type of changes in POLST forms Baseline and Last visit -12 weeks Type of changes in Physician's Orders for Life-Sustaining Treatment -POLST forms
Change in Depression Status Baseline and Last visit -12 weeks Depression as measured by the Patient Health Questionnaire-9 (PHQ-9)
Subscales:
- Question 1: Minimum value: 0 Maximum value: 27
High score means: worst outcome Low score means: better outcome
- Question 2: Minimum value: 1 Maximum value: 4
High score means: worst outcome Low score means: better outcomeChange in Cognitive Status Baseline and Last visit -12 weeks Cognition as measured by the Montreal - Cognitive Assessment (MoCA)
Minimum value: 0 Maximum value: 30
High score means: better outcome Low score means: worst outcome
Trial Locations
- Locations (2)
University of California San Francisco - UCSF
🇺🇸San Francisco, California, United States
University of Utah
🇺🇸Salt Lake City, Utah, United States