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

Project Information

Corita R. Grudzen MD, MS
New York University School of Medicine
$12,243,682
Emergency-Department Initiated Palliative Care in Older Adults with Advanced Illness

Key Dates

July 2017
December 2023
2017

Study Registration Information

Tags

Award Type
Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
Populations Populations PCORI is interested in research that seeks to better understand how different clinical and health system options work for different people. These populations are frequently studied in our portfolio or identified as being of interest by our stakeholders. View Glossary
Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: March 4, 2022