Improving Palliative Care Access Through Technology (ImPAcTT): A Multi- Component Pilot Study
试验速览
- 阶段
- 不适用
- 状态
- 暂停
- 入组人数
- 81
- 试验地点
- 2
- 主要终点
- Change in Symptom distress (composite measure)
研究概览
简要总结
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.
详细描述
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.
研究设计
- 研究类型
- Interventional
- 分配方式
- Non Randomized
- 干预模型
- Parallel
- 主要目的
- Supportive Care
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Purposeful sampling will take place in an attempt to collect data from a range of ethnically and racially diverse participants.
- •INCLUSION CRITERIA:
- •Primary participant
- •Age >= 18 years
- •English language fluency
- •Palliative Care Consult Screening Tool (PCCS) scoring 9 or above
- •If participant does not demonstrate capacity to consent, he/she must be able to assent to study procedures, be told of plan to approach surrogate and have a legally authorized representative available to provide consent
- •Family/friend caregivers:
- •Closest relative/next of kin/friend who is involved in the care of his/her loved one before and during the study period
- •English fluency
排除标准
- •Primary participant:
- •Enrolled in hospice
- •Unable to assent to study procedures
- •Expresses resistance or dissent to participation or the use of surrogate consent
- •Family/friend caregiver:
- •Life expectancy < 1 year (e.g., metastatic cancer)
- •Evidence of cognitive impairment or inability to consent to study procedures
研究组 & 干预措施
ImPAcTT intervention
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.
干预措施: Telehealth visit (Other)
Usual care
Participants will receive the standard of care established at the NH.
结局指标
主要结局
Change in Symptom distress (composite measure)
时间窗: 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 outcome
Change in Symptom impact
时间窗: 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
次要结局
- Change in number of completed POLST forms(Baseline and Last visit -12 weeks)
- Number of residents transitioned to hospice(Last visit - week 12)
- Number of In-hospital death(Baseline and Last visit -12 weeks)
- Change in Functional Status(Baseline and Last visit -12 weeks)
- Change in Mortality(Baseline and Last visit -12 weeks)
- Change in Family Satisfaction(Baseline and Last visit -12 weeks)
- Change in acute care utilization (composite measure)(Baseline and Last visit -12 weeks)
- Type of changes in POLST forms(Baseline and Last visit -12 weeks)
- Change in Depression Status(Baseline and Last visit -12 weeks)
- Change in Cognitive Status(Baseline and Last visit -12 weeks)
研究者
Caroline Stephens
PhD, RN, GNP-BC, FAAN, Helen Lowe Bamberger Colby Presidential Endowed Chair in Gerontological Nursing, Associate Professor
University of Utah