Palliative Care Interventions for Serious Illness
(NEEDS-PC Trial)

Recruiting in Palo Alto (17 mi)

+8 other locations

Overseen ByKatherine Courtright, MD, MS

Age: 18+

Sex: Any

Travel: May be covered

Time Reimbursement: Varies

Trial Phase: Academic

Waitlist Available

Sponsor: University of Pennsylvania

No Placebo Group

Trial Summary

What is the purpose of this trial?This stepped-wedge, cluster randomized pragmatic trial among 9 MedStar hospitals for patients with serious illness and unmet palliative care (PC) needs will test two interventions embedded within the electronic health record (EHR): (1) a PC needs triggered alert to opt-in to PC consults nudging hospital clinicians to order specialty PC consults for eligible inpatients, and (2) a palliative care needs triggered alert with an opt-out to palliative care consults. The trial will compare the interventions effects to usual care, focusing on hospital-free days through 6 months and other secondary outcomes. The trial also includes an embedded mixed methods study to explore factors influencing the effectiveness and equity of intervention implementation.

Eligibility Criteria

This trial is for hospitalized patients with serious illnesses who have unmet palliative care needs. It's designed to see if certain prompts in the hospital's electronic health record can help these patients receive specialized palliative care more effectively and equitably.

Inclusion Criteria

I am currently hospitalized.

I am 18 years old or older.

Exclusion Criteria

I have been officially discharged from the hospital.

I am currently admitted for hospice, rehab, psychiatric, obstetric, or neonatal care.

Participant Groups

The study tests two EHR-based interventions: one that alerts clinicians to opt-in for a specialty palliative care consult, and another that automatically opts patients in unless declined. The effectiveness of these methods will be compared to usual care practices.

3Treatment groups

Active Control

Group I: Palliative care needs information provisionActive Control1 Intervention

Clinicians will receive an EHR alert providing information about a patient's serious illness diagnosis(-es) and unmet palliative care needs

Group II: Palliative care needs information provision + default consult orderActive Control1 Intervention

The palliative care needs information provision intervention will be supplemented with a default palliative care consult order such that clinicians will receive an EHR alert providing information about a patient's serious illness diagnosis(-es) and unmet palliative care needs, and offered the choice to cancel the default consult order.

Group III: Control/Usual CareActive Control1 Intervention

During the control phase, patients meeting eligibility criteria will be enrolled for study data collection but there will be no attempt to influence delivery of care. All hospitals will contribute a minimum of 3 months of outcomes data prior to adopting the intervention. The total duration of the control phase will differ for each hospital dependent on their randomly assigned time to adopt Intervention 1 in this stepped-wedge trial design.