Status:
COMPLETED
A Needs-focused Palliative Care Intervention for Older Adults in ICUs
Lead Sponsor:
Duke University
Collaborating Sponsors:
National Institute on Aging (NIA)
Conditions:
Palliative Care
Critical Illness
Eligibility:
All Genders
50+ years
Phase:
NA
Brief Summary
The quality of intensive care unit (ICU)-based palliative care is highly variable, particularly for the 2 million older adults admitted annually to ICUs. To address these care delivery barriers among ...
Detailed Description
The quality of intensive care unit (ICU)-based palliative care is highly variable, particularly for the 2 million older adults admitted annually to ICUs. However, improving care quality on a broad sca...
Eligibility Criteria
Inclusion
- PATIENTS
- ≥50 years of age
- Receive care in a study ICU for ≥24 hours
- Meets ≥1 of 9 high risk phenotypes a. Dementia (e.g., Alzheimer's, multi-infarct, other dementia etiology) b. Declining health status defined by EITHER: i. ≥2 hospital admissions in 3 months preceding current admission OR ii. \>1 ICU admission in 3 months preceding current admission c. Poor functional status defined by EITHER: i. admit from Skilled Nursing Facility (SNF) or Long-Term Acute Care (LTAC) facility OR ii. ≥3 activities of daily living (ADL) limitations at admission d. Severe acute illness defined by EITHER: i. cardiac arrest OR ii. multisystem organ failure (≥3 of: lung, kidney, hematological, brain, cardiac, liver) that has worsened over 48 hours (i.e., Sequential Organ Failure Assessment \[SOFA\] score increase) e. Severe acute stroke (e.g., acute intracranial hemorrhage, ischemic stroke, or traumatic brain injury) f. Acute respiratory failure (ventilation or high oxygen support for ≥24 hours) g. Acute renal failure (new hemodialysis or continuous venovenous hemodiafiltration for ≥1 hour) h. Advanced cancer (Advanced / metastatic cancer diagnosis) i. Shock (use of vasopressor or inotrope for ≥4 hours)
- Exclusion Criteria (pre-consent):
- Palliative care consultation performed during the hospitalization before eligibility determination
- Current admission to ICU at the index hospital ≥8 days
- Imprisoned
- No known family or surrogate decision maker
- Death expected within 24 hours
- Exclusion Criteria (post-consent):
- \- Patient dies before T2
- FAMILY MEMBER
- ≥18 years of age
- Self-described as the individual (related or unrelated) who provides the most support and with whom the patient has a significant relationship (per definition of 'family' described in the Society of Critical Care Medicine 2016 Guidelines for Family-Centered Care in the Neonatal, Pediatric, and Adult ICU)
- Exclusion Criteria (pre-consent):
- Lack a knowledge of English such that the potential participant is not confident that they could complete study tasks (app viewing, surveys)
- Imprisoned
- Unable to complete surveys for any reason
- Exclusion Criteria (post-consent):
- \- Low need burden (NEST score \<10) at baseline
- ICU PHYSICIANS
- ≥18 years of age
- Attending or fellow physician in a study ICU
Exclusion
- \- None
Key Trial Info
Start Date :
February 22 2021
Trial Type :
INTERVENTIONAL
Allocation :
ACTUAL
End Date :
December 17 2023
Estimated Enrollment :
151 Patients enrolled
Trial Details
Trial ID
NCT04414787
Start Date
February 22 2021
End Date
December 17 2023
Last Update
July 18 2025
Active Locations (1)
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1
Duke University Medical Center
Durham, North Carolina, United States, 27710