Identification of Elderly Patients in Need of Palliative Care by Family Physicians

Study Overview
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Brief Summary
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In the last decades, the number of people living with chronic diseases had increased, mainly due to the aging of the population. Such chronic, progressive, life threatening and burdening diseases, play an important role in this new era of palliative care. Despite the growing scientific and social interest in palliative care, there is still a delay in the identification of patients with palliative care needs. This leads to a late integration in a palliative care network and consequent deprivation of the major advantages of an early and progressive integration. The aim of this study is to evaluate the role of palliative care training and the use of a structured tool, in the identification of the elderly population in need of palliative care by family physicians. And also to conduct a prevalence study to further the knowledge about how many elder people in primary care have the need of a palliative care approach.

Detailed Description
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The study consists of two phases: Randomized trial with General Practitioners (GP) to determine the role of two different training programs and a structured tool in the identification of geriatric patients with palliative care needs. Cross-sectional, analytical study of the prevalence and patterns of geriatric patients with Palliative Care (PC) needs, managed in primary care in Portugal's Center Healthcare Administrative Region.

Official Title
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Identification of Elderly Patients in Need of Palliative Care by Family Physicians - the Role of Palliative Care Training and the Use of a Standardized Tool (GerPal_ID). A Two-phase Protocol: Randomized Trial and Prevalence Study

Conditions
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Palliative Care, Primary Health Care, Geriatrics

Intervention / Treatment
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* Other: Palliative care training


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: GPs (fellows and specialists) from Center Healthcare Administrative Region Exclusion Criteria: Previous palliative care training. Refuse to participate
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Screening
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: The GPs (fellows and specialists) from Center Healthcare Administrative Region will be invited to take part in this trial. The invitations will be conducted with the help of the Center Healthcare Administrative Region and by spreading the invitation in some general practice professionals' mailing lists and online platforms. First, GPs will be contacted and those who accept to participate will be randomized into one of the four-harm study groups - 1. Control Group, 2. Identification tool group, 3. Standard PC training, 4 - Clinical cases based PC training. The accuracy on the identification before and after intervention will be compared within each group and between the four groups using a clinical record based identification tool (CCB-PCId). A PC expert panel will build a tool, clinical record based, to evaluate the accuracy of palliative care needs identification.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Control group<br>GPs (fellows and specialists) from Center Healthcare Administrative Region that will be given no intervention | |
| Experimental: Identification tool group<br>GPs (fellows and specialists) from Center Healthcare Administrative Region that will receive access to the Identification tool Supportive and Palliative Care Indicators Tool (SPICT-PT) with a brief training on how to use it. | Other: Palliative care training<br>* Intervention will consist on providing different types of palliative care training to identify the most accurate on improving GPs' identification of palliative care patients skills<br>|
| Experimental: Standard Palliative Care Training<br>GPs (fellows and specialists) from Center Healthcare Administrative Region that will receive palliative care training according to the Center Healthcare Administrative Region standard model of training. | Other: Palliative care training<br>* Intervention will consist on providing different types of palliative care training to identify the most accurate on improving GPs' identification of palliative care patients skills<br>|
| Experimental: Clinical cases based Palliative Care Training<br>GPs (fellows and specialists) from Center Healthcare Administrative Region that will receive palliative care training using a clinical cases based model. | Other: Palliative care training<br>* Intervention will consist on providing different types of palliative care training to identify the most accurate on improving GPs' identification of palliative care patients skills<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| GPs' rate of identification of patients with palliative care needs | Each GP will have to identify, before each intervention, from a set of fictitious clinical cases constructed for this purpose, which patients need palliative care. After each intervention, they will re-evaluate the same clinical cases and will be asked to identify again which patients need palliative care. Each intervention will be measured according to the identification accuracy. | 2 weeks | 
| Prevalence geriatric patients with palliative care needs | Number (% of patients) of geriatric patients, managed in primary care in Center Healthcare Administrative Region, with palliative care needs. | 6 months | 
| Sociodemographic characteristics of geriatric patients with palliative care needs | Age (in years), sex (male or female), marital status (single, married, divorced, widow, marriage) and job of geriatric patients, managed in primary care in Center Healthcare Administrative Region, with palliative care needs. | 6 months | 
| Clinical characteristics of geriatric patients with palliative care need | Main diseases, main symptoms, number of contacts with GP/year of geriatric patients, managed in primary care in Center Healthcare Administrative Region, with palliative care needs. | 6 months | 
| Complexity of geriatric patients with palliative care need | Complexity of of geriatric patients, managed in primary care in Center Healthcare Administrative Region, with palliative care needs, evaluated using ICD-Pal tool | 6 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Palliative care, Primary health care, Palliative care training, Prevalence, Geriatrics