ProPACC: protocol for a trial of integrated specialty palliative care for critically ill older adults
SK Andersen, G Vincent, RA Butler, EHP Brown… - Journal of pain and …, 2022 - Elsevier
SK Andersen, G Vincent, RA Butler, EHP Brown, D Maloney, S Khalid, R Oanesa, J Yun…
Journal of pain and symptom management, 2022•ElsevierBackground 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 …
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 …
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.
Elsevier
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