CMOT Protocol for End of Life Care
Palo Alto (17 mi)Overseen byCorey R Fehnel, MD, MPH
Age: 18+
Sex: Any
Travel: May be covered
Time Reimbursement: Varies
Trial Phase: N/A
Recruiting
Sponsor: Beth Israel Deaconess Medical Center
No Placebo Group
Approved in 3 jurisdictions
Trial Summary
What is the purpose of this trial?This trial tests a new method called Comfort Measures Only Time Out (CMOT) for ICU teams. It involves a structured pause and checklist to ensure patients are comfortable when their ventilator is removed. The goal is to reduce distress in patients during this process.
Is the CMOT Protocol for End of Life Care a promising treatment?The CMOT Protocol for End of Life Care is a promising treatment because it provides a structured way to ensure patients are comfortable during their final days. It helps healthcare providers focus on managing symptoms effectively, which can improve the quality of care for patients who are nearing the end of their lives.12367
What safety data exists for Comfort Measures Only (CMO) in end-of-life care?The research does not provide specific safety data for Comfort Measures Only (CMO) in end-of-life care. It highlights the inconsistent understanding and application of CMO among healthcare providers, the impact of CMO orders on end-of-life care, and the need for standardized protocols. However, it does not directly address safety data or outcomes related to CMO.23467
What data supports the idea that CMOT Protocol for End of Life Care is an effective treatment?The available research shows that using the Comfort Measures Only (CMO) protocol can improve end-of-life care by focusing on patient comfort. For example, one study found that patients with CMO orders received better care compared to those without such orders. This suggests that the protocol helps meet the standards for palliative care, which aims to make patients as comfortable as possible in their final days. However, another study pointed out that these comfort measures are sometimes applied too late, indicating a need for better timing and adherence to the protocol. Overall, the data supports the idea that CMOT is effective in improving the quality of end-of-life care by ensuring that patients' comfort needs are prioritized.23567
Do I need to stop my current medications for this trial?The protocol does not specify whether you need to stop taking your current medications.
Eligibility Criteria
This trial is for adults over 18 involved in ICU care, including nurses, physicians, and respiratory therapists who will be providing at least one hour of pre-extubation care to patients facing the end of life due to conditions like respiratory failure. Participants must speak English and be part of a team where the decision for withdrawal of mechanical ventilation has been made.Inclusion Criteria
I or my surrogate and the ICU team have decided to stop using the breathing machine.
I am 18 years old or older.
I have cared for a ventilated patient for at least 1 hour before they were taken off the ventilator.
Exclusion Criteria
I cannot communicate in English.
Treatment Details
The study is testing a new protocol called Comfort Measures Only Time Out (CMOT), which involves a structured time out with a checklist for ICU teams. This aims to improve patient comfort during the process of withdrawing from ventilator support at the end-of-life stage in ICUs.
1Treatment groups
Experimental Treatment
Group I: Check-list ArmExperimental Treatment1 Intervention
This feasibility study will test an ICU team-based time and and check-list intervention, the Comfort Measures Only Time Out (CMOT). The CMOT is designed to improve ICU team communication and better address patient comfort at the end of life. Participants in the CMOT are intensive care unit clinicians who are caring for a patient who is about to undergo palliative withdrawal of mechanical ventilation at the end of life. Feasibility will be assessed by: recruitment rates, protocol adherence, and acceptability to clinicians. Patient level outcomes such as distressful episodes/person-time alive will also be collected as a component of routine care in this exploratory analysis. The maximum time any participant (ICU clinician or patient) will be participating in the study is about four hours.
Find a clinic near you
Research locations nearbySelect from list below to view details:
Beth Israel Deaconess Medical centerBoston, MA
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Who is running the clinical trial?
Beth Israel Deaconess Medical CenterLead Sponsor
National Institute on Aging (NIA)Collaborator
Hebrew SeniorLifeCollaborator
References
Assessment of implementation of an order protocol for end-of-life symptom management. [2021]Designing comfort care plans to treat symptoms at the end-of-life in the hospital is challenging. We evaluated the implementation of an inpatient end-of-life symptom management order (ESMO) protocol that guides the use of opiate medications and other modalities to provide palliation.
Impact of writing "comfort measures only" orders in a community teaching hospital. [2010]We compared end-of-life care for patients with and without orders for "comfort measures only" (CMO) and evaluated whether standards for palliative medicine were met.
Missed opportunities: use of an end-of-life symptom management order protocol among inpatients dying expected deaths. [2021]When a patient is expected to die, the ideal plan of care focuses on comfort. Prior investigation of application of one institution's end-of-life symptom management order (ESMO) protocol suggested that comfort measures were often instituted too late and sometimes not at all. We studied patient factors associated with missed opportunities for use of an ESMO protocol and protocol adherence in order to identify areas for quality improvement.
Comfort measures only: agreeing on a common definition through a survey. [2012]Despite how frequently we say "comfort measures only" (CMO) in the hospital setting, review of the medical literature yields poor representation and definition of the term. Through a survey in our hospital center, we aimed at understanding what doctors understand as CMO. A total of 176 physicians responded to the survey. We asked them about the moment in the patient care timeline when to use it and what degree of respiratory support, laboratory draws, antibiotic therapy, level of care, and code status should be a part of it. Disparities in responses were the norm, and common defining characteristics were the exception.
Capture, transfer, and feedback of patient-centered outcomes data in palliative care populations: does it make a difference? A systematic review. [2022]Patient-centered outcome measures (PCOMs) are an important way of promoting patient-professional communication. However, evidence regarding their implementation in palliative care is limited, as is evidence of the impact on care quality and outcomes.
The Comfort Measures Order Set at a Tertiary Care Academic Hospital: Is There a Comparable Difference in End-of-Life Care Between Patients Dying in Acute Care When CMOS Is Utilized? [2018]Standardized protocols have been previously shown to be helpful in managing end-of-life (EOL) care in hospital. The comfort measures order set (CMOS), a standardized framework for assessing imminently dying patients' symptoms and needs, was implemented at a tertiary academic hospital.
The meaning of comfort measures only order sets for hospital-based palliative care providers. [2022]Label="PURPOSE" NlmCategory="OBJECTIVE"> Comfort Measures Only (CMO) is a label commonly used in the USA that guides the care of a hospitalized patient who is likely to die. The CMO label has unclear and inconsistent meaning, calling to question the experiences and practices of hospital-basedalliative care providers. The purpose of this study was to understand the meaning of CMO as experienced by hospital-based palliative care providers.