Clinical trial NCT03958552: Palliative Care Consultations in the Skilled Nursing Facility (SNF) Setting
Official title: Palliative Care Consultations for Persons in the Medicare Skilled Nursing Facility (SNF) Setting
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Palliative Care
Advance Care Planning
Skilled Nursing Facilities
Keywords: Palliative Care Consultation
Medicare
Skilled Nursing
Lead sponsor: University of Maryland, Baltimore
Sponsor class: OTHER
First posted: 2019-05-22
Enrollment: 45
Sex: ALL
Minimum age (years): 60
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NON_RANDOMIZED
Intervention model: PARALLEL
Intervention model description: Pre-post design where control data will be collected prior to intervention being implemented
Primary purpose: SUPPORTIVE_CARE

Brief summary: Close to one-third of Medicare decedents use the Medicare skilled nursing facility (SNF) benefit in the 6 months prior to death. SNF care often increases the risk for more aggressive, potentially burdensome treatments and unrecognized or undertreated symptoms. Palliative care is goal-directed, patient and family-centered care that focuses on a wide range of physical, psychosocial, and spiritual needs for persons with serious, life-limiting illnesses. Effective palliative care relieves suffering, enhances communication, and improves end-of-life care and decision making for seriously ill older adults. Despite its association with improved quality of care, higher satisfaction, and better symptom management at the end of life, palliative care is not widely available to Medicare patients in the Skilled Nursing Facility (SNF) setting. Palliative care consultation (PCC) is one approach that can potentially improve care for older adults with advanced illness in SNFs. This pilot study will test an evidence-based palliative care consult intervention for older adult SNF patients in nursing homes by comparing the patient/family caregiver reported quality of life in two participant groups: one receiving a PCC and the other receiving standard care.


Eligibility criteria: Inclusion Criteria:

* Admitted to a participating nursing home under the Medicare SNF benefit
* English speaking
* If non-verbal or unable to participate in a conversation, a legally authorized representative(LAR) or surrogate decision maker who can participate in the study
* A diagnosis of one or more advanced serious illness using established criteria
* One global indicator for a PCC at SNF admission (i.e., primary provider would not be surprised if patient died in 12 months; frequent hospital or SNF admissions; complex care requirements; decline in function; feeding intolerance; or unintended decline in weight)

Exclusion Criteria:

* Patients who have previously received or are referred for a SNF-based PCC by their primary care team

Primary outcomes:
measure: Number of Participants Who Completed Patient Quality of Life Surveys
timeFrame: Collected upon admission to the nursing home and enrollment and again 15-21 days after enrollment in the study (control group) or intervention received (intervention group).
Secondary outcomes:
measure: Number of Participants Who Completed the Consult Satisfaction Survey (CSQ)
timeFrame: Collected within 15-21days of palliative care consultation for the intervention group.
measure: Adherence to SNF-PCC Recommendations
timeFrame: 30 Days post-admission
Other outcomes:
Locations:
city: Philadelphia
country: United States
facility: Acts Continuing Care Retirement Communities
state: Pennsylvania
Study officials:
affiliation: UMSON
name: Joan Carpenter, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Aragon K, Covinsky K, Miao Y, Boscardin WJ, Flint L, Smith AK. Use of the Medicare posthospitalization skilled nursing benefit in the last 6 months of life. Arch Intern Med. 2012 Nov 12;172(20):1573-9. doi: 10.1001/archinternmed.2012.4451.
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