The primary objective is to evaluate the effect of the PalliSupport care pathway on the likelihood of unplanned hospital readmission, deaths at place of preference, quality of life, symptom burden and informal caregiver burden.
ID
Source
Brief title
Condition
- Other condition
Synonym
Health condition
Kwetsbaarheid en/of ongeneeslijke aandoening met een levensverwachting van minder dan een jaar
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
The primary outcome is the occurrence of (at least one) unplanned
hospitalisation in the six months after discharge.
Secondary outcome
Secondary outcomes are dying at the place of patient*s preference. Furthermore,
the quality of life, symptom burden, palliative outcomes, caregivers* burden
and health care utilisation will be assessed.
Background summary
Inadequate palliative care for older patients can result in unnecessary
hospitalisation, reduced quality of life and patients not dying at their place
of preference. Barriers to appropriate palliative care can be found at the
organisational, communicational, educational and cultural levels. The
PalliSupport care pathways aim to overcome these barriers by providing
patient-centred care by means of timely identification of patients who could
benefit and integral palliative assessment: timely conversations about their
wishes and preferences. Furthermore, PalliSupport aims to enhance knowledge of
health care providers and improve collaboration between care settings.
Study objective
The primary objective is to evaluate the effect of the PalliSupport care
pathway on the likelihood of unplanned hospital readmission, deaths at place of
preference, quality of life, symptom burden and informal caregiver burden.
Study design
This study will be a pragmatic multicentre stepped-wedge randomised trial
(SW-RCT) in 5 hospitals and surrounding regions (clusters). 300 patients will
be included in the care a usual phase and 300 in the intervention phase.
Intervention
The intervention consists of a transitional care pathway that starts during an
acute hospitalisation. The intervention consists of timely identification with
the Surprise Question and SPICT criteria. After identification, conversations
about end-of-life preferences will be initiated and an integral palliative
assessment will be performed by the palliative care team. The patient will be
discussed in a weekly multidisciplinary meeting (MDT), which is attended by the
patient*s primary care physician and home care nurse, and an individualised
palliative care plan will be formalised. During the MDT the intensity of
follow-up will be determined. Before discharge the patient and their informal
caregiver will receive a copy of the individualised care plan; a copy will also
be sent to the primary care physicians and home care services. After discharge
the patient is followed up by the palliative care team and discussed in the MDT
until this is deemed no longer necessary. Primary care professionals can
consult the palliative care team again if new problems occur.
Study burden and risks
The risks of participation are limited for patients and their informal
caregivers. Most of the interventions occur on health care providers and
organisational level. One of the interventions is conversations about the
wishes and needs around the end of life. This could be confrontational and
cause fear and sadness. On the other hand this could also result in care that
is better adjusted to the needs and wishes of the patient. The burden for
patients and their informal caregivers is low, during baseline and at four
follow-up moments, four questionnaires will be presented. A small sample will
also be approached for interviews which will last an hour.
Meibergdreef 9
Amsterdam 1105AZ
NL
Meibergdreef 9
Amsterdam 1105AZ
NL
Listed location countries
Age
Inclusion criteria
1) Age (*65 years);
2) Acutely admitted for *48 hours to the departments of internal medicine, geriatrics, cardiology, pulmonary disease, gastroenterology or oncology;
3) Positive SPICT* criteria*: a hospital admission in six months prior to admission, functional status decline and weight loss (65-79 years: two or more positive criteria, >80 years: 1 or more positive criteria);
4) Ability to read and speak the Dutch language;
Exclusion criteria
Patients who are not able to answer questionnaires due to severe cognitive impairment (MMSE<15) due to diagnosis of dementia or active delirium during the entire admission, will be excluded. Furthermore, patients who live far from the hospital and therefore cannot be visited by the palliative care team will be excluded (based on ZIP code area).
Design
Recruitment
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
| Register | ID |
|---|---|
| CCMO | NL66739.018.18 |