Palliative Care, Telehealth
Conditions
Keywords
End of life, Care transition, Nursing Home
Brief summary
This project will focus on developing, optimizing and pilot-testing a multi-component Improving Access Through Technology (ImPAcTT) intervention that leverages existing telehealth technologies to provide staff education; family outreach, engagement and support; care coordination; and resident symptom management and facilitation of goals-of-care discussion.
Detailed description
Almost 1.8 million older Americans live in nursing homes (NH), with estimates that this number will grow to more than 3 million by 2050. NHs are increasingly becoming the place of care and site of death for frail older adults dying from multiple chronic illnesses. Unfortunately, most residents die without the benefit of palliative care (PC) or with palliation delayed until the last days of life. Unfortunately, hospice services are often the only formal end of life care service available in NHs, and access to hospice enrollment is complicated by financial implications for both NHs and residents. Telehealth, or remote monitoring of patients through information and communication technologies, is an effective mechanism for addressing the increased demand on health services and has much to offer to people living with and dying from advanced illness. Moreover, numerous studies have demonstrated positive benefits of using telehealth in the NH to improve access to consultants (e.g., neurology, dermatology, psychiatry). Little is known, however, about the effect of using Telehealth on improving access to PC specialists in the NH setting. The proposed ImPAcTT intervention employs a secure communications platform that permits multi-person live video, audio, and text message consultations; real-time document sharing and documentation for advanced care planning discussions; and remote virtual assessment capabilities. The investigator will conduct a pilot implementation trial of ImPAcTT in 3 study nursing homes to evaluate our ability to safely recruit and retain study participants, collect appropriate and accurate data, and determine preliminary estimates of an effect size of the intervention.
Interventions
OTHERTelehealth visit
ImPACTT Telehealth visit with the PC provider
Sponsors
National Institute on Aging (NIA)
University of Utah
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Intervention model description
The trial will be implemented in 3 nursing homes to evaluate the feasibility and acceptability of the multi-component ImPAcTT intervention.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Purposeful sampling will take place in an attempt to collect data from a range of ethnically and racially diverse participants. INCLUSION CRITERIA: Primary participant * Age \>= 18 years * English language fluency * Palliative Care Consult Screening Tool (PCCS) scoring 9 or above * If participant does not demonstrate capacity to consent, he/she must be able to assent to study procedures, be told of plan to approach surrogate and have a legally authorized representative available to provide consent Family/friend caregivers: * Closest relative/next of kin/friend who is involved in the care of his/her loved one before and during the study period * English fluency
Exclusion criteria
Primary participant: * Enrolled in hospice * Unable to assent to study procedures * Expresses resistance or dissent to participation or the use of surrogate consent Family/friend caregiver: * Life expectancy \< 1 year (e.g., metastatic cancer) * Evidence of cognitive impairment or inability to consent to study procedures
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Symptom distress (composite measure) | Baseline and Last visit -12 weeks | Symptom distress as measured by the Edmonton Symptom Assessment Scale - ESAS * ESAS physical score (total of physical 6 symptoms, score range 0-60) * ESAS emotional score (total of 2 emotional symptoms, score range 0-60) * ESAS total symptom distress score (physical score + emotional score + well being) For all symptom distress scores: High score means: worst outcome Low score means: better outcome |
| Change in Symptom impact | Baseline and Last visit -12 weeks | Symptom impact as measured by the Quality of Life at the End of Life - QUAL-E Symptom impact subscale: Minimum value: 3 Maximum value: 15 High score means: worst outcome Low score means: better outcome |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Type of changes in POLST forms | Baseline and Last visit -12 weeks | Type of changes in Physician's Orders for Life-Sustaining Treatment -POLST forms |
| Number of In-hospital death | Baseline and Last visit -12 weeks | Number of In-hospital death |
| Change in Family Satisfaction | Baseline and Last visit -12 weeks | Family Satisfaction as measured by the Quality of Life at the End of Life - Family - QUAL-E Fam Subscale: Relationship with Healthcare Provider \[Questions #5-8 with 5 item Likert scales, average of 4 scores\] Minimum value: 1 Maximum value: 5 High score means: worst outcome Low score means: better outcome |
| Number of residents transitioned to hospice | Last visit - week 12 | Number of residents transitioned to hospice |
| Change in Cognitive Status | Baseline and Last visit -12 weeks | Cognition as measured by the Montreal - Cognitive Assessment (MoCA) Minimum value: 0 Maximum value: 30 High score means: better outcome Low score means: worst outcome |
| Change in Functional Status | Baseline and Last visit -12 weeks | Functional Status as measured by the PalliativePerformance Scale (PPSv2) Minimum value: 0% Maximum value: 100% High score means: better outcome Low score means: worst outcome |
| Change in Depression Status | Baseline and Last visit -12 weeks | Depression as measured by the Patient Health Questionnaire-9 (PHQ-9) Subscales: \- Question 1: Minimum value: 0 Maximum value: 27 High score means: worst outcome Low score means: better outcome \- Question 2: Minimum value: 1 Maximum value: 4 High score means: worst outcome Low score means: better outcome |
| Change in Mortality | Baseline and Last visit -12 weeks | Risk for dying within one year as measured by the Flacker Mortality Score Minimum value: 0 Maximum value: 15.21 High score means: worst outcome Low score means: better outcome |
| Change in acute care utilization (composite measure) | Baseline and Last visit -12 weeks | Number of ED Visits and number of Hospitalizations |
| Change in number of completed POLST forms | Baseline and Last visit -12 weeks | Number of Physician's Orders for Life-Sustaining Treatment - POLST forms completed |
Countries
United States
Outcome results
None listed