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  • Research & Results
  • Explore Our Portfolio
  • Comparing Two Ways to Provide Palliat...

Comparing Two Ways to Provide Palliative Care to Older Adults with Serious Illness

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Project Summary  

This research project is in progress. PCORI will post the research findings on this page within 90 days after the results are final.

What is the research about?

Palliative care focuses on easing suffering and improving quality of life for patients with a serious illness and their families. This type of care can include physical, emotional, social, and spiritual support.

But not all patients with a serious illness get palliative care. Going to the emergency department, or ED, can be a sign that people with serious illness need more help managing their health problem. Half of older Americans visit the ED in the last month of life.

This study is comparing two ways to give palliative care to older adults with serious illness. The first way is phone calls from a nurse case manager. The second way is in-person help at a clinic that specializes in palliative care.

Who can this research help?

Hospital and health insurance administrators can use findings from this study to learn about ways to help older adults get access to palliative care.

What is the research team doing?

The research team is working with nine EDs across the country to enroll 1,350 adults ages 65 and older who have either advanced cancer or organ failure. Patients must live at home. In addition, the team is enrolling 675 caregivers of patients in the study. The team is assigning patients and their caregivers by chance to one of two groups. Each group has equal numbers of patients with cancer or organ failure. Patients in one group get support from a nurse case manager over the phone. The case manager helps with managing illnesses, day-to-day needs, working with the medical team, and connecting patients with services in the community. Patients in the other group go to a clinic that specializes in palliative care. These patients get help with managing symptoms and stress related to their illnesses. Over six months, the team is comparing changes in patients’ and caregivers’ quality of life, healthcare use, loneliness, and grief. Caregivers also report changes in the burden they feel during this time.

The research team is working with patients, healthcare providers, and representatives from education, nursing, and social support organizations, as well as a large Medicare Advantage plan to design and conduct this study.

Research methods at a glance

Design Elements Description
Design Randomized controlled trial
Population Adults 65 years and older with advanced cancer or end-stage organ failure who live at home and are scheduled for discharge from the ED, and their caregivers
Interventions/
Comparators
  • Nurse-led telephone case management (nurse-led interviews)
  • Outpatient specialty palliative care (physician-led interviews)
Outcomes

Primary: quality of life

Secondary: healthcare use, loneliness, bereavement, and caregiver burden

Timeframe 6-month follow-up for primary outcome

Journal Articles

Related Articles

Journal of Palliative Medicine

Development of an Outpatient Palliative Care Protocol to Monitor Fidelity in the Emergency Medicine Palliative Care Access Trial

BMJ Open

Emergency Medicine Palliative Care Access (EMPallA):protocol for a multicenter randomised controlled trial comparing the effectiveness of specialty outpatient versus nurse-led telephonic palliative care of older adults with advanced illness

Project Details

Principal Investigator
Corita R. Grudzen MD, MS
Project Status
In progress; Recruiting
Project Title
Emergency-Department Initiated Palliative Care in Older Adults with Advanced Illness
Board Approval Date
July 2017
Project End Date
December 2023
Organization
New York University School of Medicine
Year Awarded
2017
State
New York
Project Type
Research Project
Health Conditions  
Cancer
Ovarian Cancer
Pancreatic Cancer
Prostate Cancer
Skin Cancer
Uterine Cancer
Breast Cancer
Cervical Cancer
Colorectal Cancer
Liver Cancer
Intestinal Cancer
Lung Cancer
Anal Cancer
Brain Cancer
Bladder Cancer
Cardiovascular Diseases
Congestive Heart Failure
Kidney Diseases
Chronic Kidney Disease
Renal Failure
Respiratory Diseases
Chronic Obstructive Pulmonary Disease
Multiple/Comorbid Chronic Conditions
Intervention Strategies
Care Coordination
Other Health Services Interventions
Patient Navigation
Training and Education Interventions
Populations
Racial/Ethnic Minorities
Older Adults
Funding Announcement
Community-Based Palliative Care Delivery for Adult Patients with Advanced Illnesses and their Caregivers
Project Budget
$12,243,682
Study Registration Information
HSRP20181691
NCT03325985
Page Last Updated: 
February 20, 2020

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